The goal of this study is to assess the reasons for the lower transplant rate among Native American patients undergoing treatment for end stage renal disease (ESRD).

Data were derived from ESRD Network No. 15, which accounts for Native Americans treated for ESRD in six states in the United States. Rates were estimated for New Mexico and Arizona, the two states with the largest Native American populations.

The transplant rate was higher for whites than for Native Americans by more then 35% in Arizona and by more than 75% in New Mexico. In both, the discrepancy was much larger in women than in men. Age-adjustment and diagnosis-adjustment changed the rates for both whites and Native Americans, but, after accounting for both factors, whites still had a higher transplant rate.

Native Americans were also transplanted later after onset of treatment. The difference was 4 and 6 months in Arizona and New Mexico, respectively.

Medical coverage was comparable between Native American and white patients in this sample. More than 75% of Native American and 83% of white patients were on Medicare, 2-4% of Native Americans used Indian Health Service; and less than 1% of ESRD patient had no payment source. Additionally, the donor sources were similar for the two groups.

This study could not access comorbid conditions, survival rates, cultural differences, difficulty with language, and provider attitudes, all of which the authors cite as possible explanations for the findings. The authors conclude that “if further analyses fail to reveal that lower transplant rates for Native Americans are justified for medical reasons, interventions may be undertaken by Indian Health Service and/or ESRD Network No 15 to attempt to increase access to transplantation for Native Americans.”