Kidney transplants are the best treatment option for eligible patients living with kidney failure. Bringing healthcare equity to the kidney transplantation conversation in rural Nova Scotia is now the focus of Dr. Amanda Vinson.
As an associate professor of medicine in kidney transplantation with Dalhousie University and a transplant nephrologist at the QEII Health Sciences Centre, Dr. Amanda Vinson’s career has been guided by curiosity. It drove her to change coasts, moving from rural British Columbia to study medicine at the University of British Columbia and then to Halifax for her internal medicine, nephrology, and transplant fellowships, with a subsequent master’s in science from Harvard University.
“My interest in access to transplant and inequities in health care in general has evolved over time. I'm from a small town, and I know some of the disadvantages my family faced growing up living in a rural community.”
When research dollars became available through the QEII Foundation’s Health Equity Fund, Dr. Vinson knew she had to apply to support her research regarding access to transplants.
“I hypothesize that rural Nova Scotians may have less access to kidney transplants and may receive less optimal care after kidney transplants than people living in urban centres. This funding is going to help identify if rural Nova Scotians have equitable access to kidney transplantation, which is a lifesaving therapy. In addition, once these patients are transplanted, we aim to examine if they are getting the same level of care as transplant recipients who live in urban communities. Are their transplant-specific issues being identified and managed as efficiently and effectively? And are their post-transplant outcomes the same as for people living in urban centres who can be seen in a tertiary hospital with more immediate access to physicians with transplant expertise, rather than presenting to rural emergency departments?”
Dr. Vinson adds the goal behind this research is not to suggest that rural medical teams in Nova Scotia aren’t doing incredible work to care for patients in rural communities.
“Our rural physician colleagues are doing outstanding jobs — they’re dealing with a million things, whereas I have the liberty of dealing with just one thing, and it's a kidney transplant. My increased familiarity with kidney transplants and the potential issues these patients face allows me to better diagnose and treat kidney transplant-related problems. There are also resource barriers faced by our rural colleagues. For example, optimal care for sick transplant recipients often includes a particular blood test (a tacrolimus level), which we can get back in a number of hours at our tertiary center, but may take four or five days to return when done at rural centers. Another issue may be access to urgent radiologic imaging, which isn’t available at all rural emergency departments. These are some of the inequalities I’m interested in learning more about.”
While the focus of the research is on kidney transplants, there will be enough funding to look at liver transplants as well. Dr. Vinson hopes the findings of the research will prompt change.
“If there are disparities in access to, or outcomes after a liver or kidney transplant for patients living in rural communities — those problems are there whether we study them or not. The most important thing is that we identify the issues so that we can address them. Maybe more patients need to come to Halifax. Maybe we need outreach clinics for these patients, or improved transplant-specific education for patients and non-specialist healthcare providers. But we need to know what the problem is before we can really institute solutions. This research will be the first step to change, if needed.”
This research will be a first of its kind in Canada, which is surprising to Dr. Vinson given a large portion of the country’s population live in rural communities.
“We want to be sure patients are receiving the care they need, regardless of where they live. I’m excited to be the one leading this research.”
This study is one Dr. Vinson has wanted to do for a while and had already started to prepare for when the QEII Foundation’s Health Equity Fund was announced. Dr. Vinson believes the funding will allow the study to dive deeper into understanding the patient experience.
“You know, I can look at statistics all day. But talking to the patients and finding out from them what they perceive to be barriers to transplant and effective healthcare is even more valuable. The funding is going to allow us to meet with patients living in rural communities to really understand the challenges they are facing and better understand the patient experience. This adds a whole new level to this research that would not happen without this funding.”
The tertiary centre transplant clinic for the province is at the Victoria General Hospital (part of the QEII Health Sciences Centre) which completes 80 to 120 kidney transplants a year. There are also doctors in Yarmouth and Cape Breton who care for transplant patients.
The benefits to those who can receive a kidney transplant include longer life expectancies compared to remaining on dialysis, and an overall better quality of life. There is also a financial benefit to the healthcare system if more people receive a successful transplant.
Dr. Vinson is tremendously grateful for the funding her project has received, but also for the Health Equity Fund itself.
“I’m so thankful to the donors, like Emera, and the QEII Foundation who are shining a light on health equity. It is something that for so long has been an underappreciated aspect of medicine. This funding is such a gift to help get this research off the ground, for me but more importantly, for our patients. If there are inequities there, we need to know what they are. It's not reasonable to continue the status quo without questioning if it’s fair for our patients.”
Dr. Vinson anticipates her research will be completed in late 2026.
The QEII Foundation’s new Health Equity Fund is providing grants to healthcare leaders and researchers whose work is advancing health equity for populations across Nova Scotia. Administered through the team at Research, Innovation, and Discovery at Nova Scotia Health, Emera’s gift will guarantee funding at $200,000 annually for the next five years.
This $1-million project is part of the QEII Foundation’s $100-million We Are campaign to transform health care at and through the QEII Health Sciences Centre.