Background: Diabetes and ESRD disproportionately affect NAs (Native Americans), yet waitlisted NAs have lower rates of kidney transplantation than other racial/ethnic groups and worse longer term survival post-transplant, implying reduced access to the transplantation system.

Methods: Using data from the Organ Procurement and Transplantation Network, we evaluate the removal reasons from the waitlist and post-transplant survival rates, comparing NA populations with other racial/ethnic groups. We use a linear probability model, controlling center and year fixed effects, and type of insurance. Regressions evaluating post-transplant survival include education, insurance status, and risk adjustment factors defined by the Scientific Registry of Transplant Recipients (SRTR). Logit specification was used for analysis.

Results: NAs are 5.8 percentage points (pp) less likely to receive a transplant, 2.3 pp more likely to die on the waitlist and 3.5 percentage points more likely to be deemed “too sick for transplant” compared to African-Americans, Hispanics, and Asians. Before incorporating education and insurance, NAs have worse survival outcomes at the three-year mark; they are 3.8 pp more likely to die by three years post-transplant, relative to whites. Once we include education and insurance, NAs no longer encounter a statistical significant decrease in post-transplant survival.

Conclusions: We find that waitlisted NAs have worse waitlist outcomes relative to other racial/ethnic groups. However, Native Americans that receive transplants do not have lower survival rates once we include education and insurance, indicating that the survival disparities for NAs lie within socio-economic factors or that these factors suggest other disparities such as reduced access to healthcare and obstacles with aftercare. Such disparities are likely more prevalent for NAs living on tribal lands, a hypothesis we will explore along with the more general correlation between being NA and socio-economic factors for adverse waitlist and survival outcomes. Our goal is to identify potential interventions that could increase the transplantation rate amongst waitlisted NAs.

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