Speaking today at the 46th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT) Jagbir Gill, MD , Associate Professor of Medicine in the Division of Nephrology at the University of British Columbia (UBC), shared practical strategies for reducing disparities in access to transplantation.
“Transplant access should mean that every potentially eligible patient has a real chance to receive one,” said Dr. Gill. “Right now, we know that’s not happening—especially for Indigenous peoples and other underserved groups.”
Drawing on years of research regarding accessing kidney transplantation and his work with Indigenous communities in Canada, Dr. Gill said inequities in transplant care are not inevitable, but rather the result of systems that weren’t designed with cultural safety in mind.
Dr. Gill and his colleagues demonstrated that access to kidney transplantation was consistently more challenging for Indigenous patients in Canada.
“There are barriers at every stage of the workup and follow-up process,” said Dr. Gill, a past president of the Canadian Society of Transplantation.
These disparities are rooted in a long history of systemic racism, such as the residential school system—a government-funded, church-run program that forcibly removed Indigenous children from their families begun in the late 19th century, which has resulted in a profound and enduring lack of trust in healthcare institutions. Geography can add another layer of obstacles.
“Many Indigenous communities are located in remote or rural regions far from transplant centers and local services on reserve often rely on nurses or visiting physicians and do not offer specialized transplant care,” he said. “The result is a system in which the people who need the most support face the highest logistical and emotional barriers.”
From Description to Action
Dr. Gill stressed that simply documenting inequities is no longer enough. “We’ve spent years describing the problem. The real question now is: what actions can we take within the parts of the system we can control?”
Rather than imposing top-down fixes, his team has co-developed practical solutions with Indigenous patients, families, and community leaders. Key elements of their approach include co-designed education, providing culturally safe spaces, and navigation support.
Storytelling instead of pamphlets
By consulting with the Indigenous community, Dr. Gill’s team learned that traditional written materials had little impact. In response, they developed videos featuring Indigenous patients who have gone through the living donation process and kidney transplantation, including prominent and respected community members. The well-received videos are now central to their education strategy.
Culturally safe care and sacred spaces
The team integrated an Indigenous wellness liaison into its transplant program to support patients in culturally appropriate ways, including facilitating spiritual practices or ceremonies. To foster a sense of safety and respect, patient education sessions and group discussions are held in a designated sacred space within the hospital, rather than in conventional clinical rooms.
Nurse navigators and coordinated workups
Research revealed that missed appointments weren’t a result of non-adherence, but rather the result of transportation and logistical hurdles, such as traveling long distances to healthcare facilities, lost wages, and a lack of childcare.
To help patients overcome these obstacles, programs schedule transplant workups as a single, carefully planned visit for remote patients, with the help of a dedicated nurse navigator who coordinates tests and appointments.
Lessons for Heart and Lung Transplantation
Dr. Gill told the ISHLT audience that the principles guiding these interventions translate directly to heart and lung transplantation, where the same structural, cultural, and geographic challenges apply. Patients must travel to the same tertiary centers, stay for complex recoveries, and navigate long-term follow-up. Similarly, the same issues of trust, racism, and representation exist in other marginalized communities globally—including Black and Latino populations in the United States and Canada.
“The same practical strategies that we’ve deployed to increase access to kidney transplants among the Indigenous population could help heart and lung programs close gaps in access,” he said.
A Model That Can Be Expanded
Dr. Gill closed by emphasizing that while his team started with the Indigenous population, the same model can and should be extended to other under-resourced groups, including non-Indigenous patients in rural areas and those facing financial hardship.
“The goal is not to just create a special track for a select few, but to ensure that those most in need are cared for in a way that ensures equity and apply our learnings to improve care for everyone,” he said.
The annual meeting and scientific sessions of ISHLT are being held from 22–25 April at the Metro Toronto Convention Centre in Toronto, ON, Canada.
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ABOUT ISHLT
The International Society for Heart and Lung Transplantation (ISHLT) is a not-for-profit, multidisciplinary, professional organization dedicated to improving the care of patients with advanced heart or lung disease through transplantation, mechanical support, and innovative therapies via research, education, and advocacy. ISHLT members focus on transplantation and a range of interventions and therapies related to advanced heart and lung disease.