title: Scarcity discourses and their impacts on renal care policy, practices, and everyday experiences in rural British Columbia.
abstract: Drawing from a qualitative case study in rural British Columbia, Canada, this paper examines the discourse of kidney scarcity and its impact on renal care policies and practices. Our findings suggest that at different levels of care, there are different discourses and treatment foci. We have identified three distinct scarcity discourses at work. At the macro policy level, the scarcity of transplantable kidneys is the dominant discourse. At the meso health care institution level, we witnessed a discourse regarding the scarcity of health care and human resources. At the micro community level, there was a discourse of the scarcity of health and life-sustaining resources. For each form of scarcity, particular responses are encouraged. At the macro level, renal care and transplant organizations emphasize the benefits of kidney transplantation and procuring more donors. At the meso level, participants from the regional health care system increasingly encourage home hemodialysis and patient-led care. At the micro level, community health care professionals push for rural renal patients to attend dialysis and maintain their care plans. This work contributes to critical, interdisciplinary organ transfer discourse by contextualizing kidney scarcity. It reveals the tension between these discourses and the implications of pursuing kidney donations without addressing the conditions in which individuals experience kidney failure.
authors: School of Health Policy and Management, York University, Room 011 Health Nursing and Environmental Studies Building, 4700 Keele St. Toronto, ON, M3J 1P3, Canada. Electronic address: jbrass@yorku.ca.
authors: Julia
authors: J
authors: Brassolotto
authors: Faculty of Health, York University, Room 411 Health Nursing and Environmental Studies Building, 4700 Keele St. Toronto ON, M3J 1P3, Canada. Electronic address: dalyt@yorku.ca.
authors: Tamara
authors: T
authors: Daly
mesh_terms: D001955:British Columbia; D005260:Female; D015276:Health Care Rationing; D006291:Health Policy; D054624:Health Status Disparities; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D036301:Qualitative Research; D006435:Renal Dialysis; D012423:Rural Health / Q000706:statistics & numerical data; D019035:Rural Health Services; D012959:Socioeconomic Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*
keywords: Canada; Health equity; Kidney scarcity; Renal care; Rural health