Abstract
In 2019, Canadian First Nations activist David Dennis challenged the 6-month alcohol abstinence requirement when he was denied placement on the liver transplant list. While Mr. Dennis was eventually placed on the waitlist, he passed away before receiving a transplant. As Canadian transplant programs seek to reduce healthcare inequities experienced by Indigenous patients—First Nations, Métis, and Inuit—this analysis sheds much needed light on the inconvenient truths of settler colonialism and the need for impactful reconciliation in Canadian healthcare. This analysis examines Dennis’ activism and his argument about the inequities in transplant medicine experienced by Indigenous patients. Dennis’ activism highlighted how the Canadian healthcare systems underserve Indigenous populations, including in transplant medicine; fails to address racial biases within healthcare; and does little to consider and address negative inter-generational determinants of health that perpetuate poor health outcomes for Indigenous populations. This analysis provides direction to decision makers in transplant and additions medicine, to Ministries of Health, and to First Nations, Métis, and Inuit healthcare leaders for improved healthcare for Indigenous patients living with alcohol-related liver disease. Without concerted and coordinated efforts to address the needs of this patient population, we will continue to see rapid deterioration of their health status and high rates of mortality will persist among this patient population.
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