#NephMadness 2023: Transgender and Gender Diverse Identities in Nephrology

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Murdoch Leeies @MLeeies

Murdoch Leeies is an organ donation, critical care medicine and emergency medicine specialist physician.  Trained as a clinician investigator, he serves as the Director of Research for the Department of Emergency Medicine at the University of Manitoba.

Dr. Leeies leads a collaborative program of research with a focus on promoting health equity in organ and tissue donation and transplantation. To ensure this work is informed by the population it aims to serve, Dr. Leeies has led the formation of a 2SLGBTQIA+ Patient & Public Advisory Team which partners in the development of patient-centered research that explores the inequities that 2SLGBTQIA+ persons face in the organ and tissue donation and transplantation system.  Through this work Dr. Leeies hopes to generate knowledge that can inform the reformation of structural and systemic elements of the health system that uphold these inequities.

This intersectional research program pairs with his clinical work as an organ donation specialist physician with the Transplant Manitoba Gift of Life program.  Dr. Leeies extends his commitment to the principles of equity, diversity, decolonization, and inclusion (EDDI) through academic and clinical service as the Director of EDDI for the Canadian Critical Care Society.

Competitors for the Transgender Health Region

Team 1: Kidney Care for the Transgender Patient vs Team 2: Gender-Affirming Care

Copyright: nito/Shutterstock

Sexual orientation and gender identity (SOGI)-diverse populations include Two-Spirit, lesbian, gay, bisexual, transgender and queer plus (2SLGBTQ+) persons and represent approximately 5% of the global population. Specifically, structural discrimination against SOGI-diverse populations is embedded in our organ and tissue donation and transplantation (OTDT) system. Policies that originated in reaction to the Human Immune-deficiency Virus (HIV) epidemic of the 1980’s have not been adequately updated in-line with our evolving understanding of the likelihood of transmission of HIV or viral hepatitis. By failing to keep pace with evolving science we continue to unnecessarily exclude or restrict organ and tissue donors based on their sexual orientation and/or gender identity, as opposed to evidence-based behavioral factors associated with transmission of HIV or viral hepatitis. These policies are stigmatizing and harmful to SOGI-diverse populations and ultimately result in reduced availability of needed organs and tissues for all patients regardless of social identity.

Transgender and gender diverse persons represent a unique population within the SOGI-diverse umbrella who have been historically underrepresented, systemically marginalized and oppressed, even within SOGI-diverse communities. Recognition of diversity of gender identities, the importance of respecting the individual through appropriate self-identified pronoun use, and identification of transgender and gender diverse-specific knowledge gaps (e.g., interactions between gender-affirming medical and surgical therapies with other renal health considerations) is a critical first step in enhancing the care of transgender and gender diverse persons. Many structural barriers, such as the need to update health information systems in order to appropriately collect and document gender identity and other variables, are simple solutions that could meaningfully enhance our ability to provide person-centred care but require attention and resourcing.

I was thrilled to see that the American Journal of Kidney Disease (AJKD) is amplifying the calls to action made by the two teams in the Transgender region this year. By focusing a region on transgender and gender diverse health, AJKD is acknowledging the inherent value and lived experiences of transgender and gender diverse persons. Our competitors should both be celebrated as winners for championing the need for enhanced epidemiologic collection of sexual orientation and gender identity at the population level, for improved healthcare worker training in cultural humility, and for further research on the interactions between gender-affirming therapies and renal health care.

Team 1 did an excellent job of summarizing inequities, potential harms, and opportunities for improvement specific to SOGI-diverse patients. Team 2 provided an overview of gender-affirming care and highlighted relevant intersections with renal care. Both have described important issues relevant to enhancing the care of transgender and gender diverse populations interfacing with renal care teams. While I applaud both teams my choice is Team 2 for including both education about transgender and gender diverse -specific care and specific opportunities for improvement.

If I were to make one final point, it would be to emphasize that appropriately resourced patient-/caregiver-/community-engagement with SOGI-diverse individuals who have lived experiences in the renal health system must be facilitated to ensure that policy revisions, research priorities, and funding allocation decisions are informed by the individuals they are intending to benefit. All human lives have value and I believe it is our duty as physicians, researchers, and leaders in the health system to work to ensure that all our patients achieve their best possible outcomes through our care.

– Guest Post written by Murdoch Leeies @MLeeies

As with all content on the AJKD Blog, the opinions expressed are those of the author of each post and are not necessarily shared or endorsed by the AJKD Blog, AJKD, the National Kidney Foundation, Elsevier, or any other entity unless explicitly stated.

Click to read the Transgender Region

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