We Need a System that's Not Designed to Fail Maori: Experiences of Racism Related to Kidney Transplantation in Aotearoa New Zealand

Background Reported experiences of racism in Aotearoa New Zealand are consistently associated with negative measures of health, self-rated health, life satisfaction, and reduced access to high-quality healthcare with subsequent poor health outcomes. In this paper, we report on perceptions and experiences of prejudice and racism by indigenous Maori with kidney disease and their family members and donors who took part in a wider study about experiences of kidney transplantation. Methods We conducted semi-structured interviews with 40 Maori between September and December 2020. Participants included those with kidney disease who had considered, were being worked up for, or who had already received a kidney transplant as well as family members and potential or previous donors. We examined the data for experiences of racism using a theoretical framework for racism on three levels: institutionalised racism, personally mediated racism, and internalised racism. Results We identified subthemes at each level of racism: institutional (excluded and devalued by health system; disease stigmatization; discriminatory body weight criteria, lack of power), personally mediated (experiencing racial profiling; explicit racism), and internalized racism (shame and unworthiness to receive a transplant). Conclusions The wide-reaching experiences and perceptions of racism described by participants with kidney disease and their families in this research point to an unfair health system and suggest that racism may be contributing to kidney transplantation inequity in Aotearoa New Zealand. Addressing racism at all levels is imperative if we are to address inequitable outcomes for Maori requiring kidney transplantation.

Automated summary

This paper examines the perceptions and experiences of prejudice and racism among indigenous Maori with kidney disease and their family members and donors. The study reveals that racism exists at institutional, personal, and internal levels, contributing to inequitable outcomes for Maori requiring kidney transplantation in Aotearoa New Zealand.