Kidney Transplant Challenges for U.S. Veterans

The expressed opinions of Dr. Mohottige are her own and do not reflect official VA policy or practice.

The US Department of Veterans Affairs (VA) reports that veterans experience kidney disease 34% more than the general population. Currently, 600,000 veterans have kidney disease, 40,000 who have kidney failure.¹ The VA performs around 160 kidney transplants per year, not counting transplants performed through the VA's referral program.² 

Why do veterans experience higher rates of kidney disease? What are people doing to help veterans get the kidney care they need? Dr. Dinushika Mohottige, a nephrologist, is here to answer these questions and more.

Following in her mother’s footsteps

Dr. Mohottige is no stranger to the effects of kidney disease. She grew up during the late 1980s while the HIV/AIDS epidemic raged. Her mother, a nephrologist, was on the front lines. She provided dialysis to patients when little was known about the virus. 

“I used to go to the hospital with her and see her care for dialysis patients. Many lost kidney function due to HIV/AIDS. It was impactful. I can still remember their faces,” Dr. Mohottige said. “I credit my mom for the inspiration to go to medical college.”

One thing stood out during Dr. Mohottige’s childhood and medical training: the healthcare system does not treat everyone equally.

“I became very motivated by equity issues. Kidney disease stood out as emblematic of deep inequities in society. There are wide disparities across race, ethnicity, income, and geography,” Dr. Mohottige said. “So many things may influence kidney care. Your race, sexual orientation, gender identity, religion, native language and more."

Medical, environmental, and social situations outside one’s control are the main culprits.

“Social determinants are the places and environments where people live, breathe, play. They influence illnesses like high blood pressure and diabetes,” said Dr. Mohottige. "Other factors that can increase risk of kidney disease include living in lower economic neighborhoods, having fewer educational opportunities, and lack of affordable access to healthy food."

When Dr. Mohottige’s medical program placed her in a VA hospital, she was surprised to learn about the unique social determinants of health that affect veterans–especially when trying to access a kidney transplant.

Learn more about social determinants of health.

Recognizing veterans’ unique challenges

Transportation, lack of support, and employment issues–these are the structural barriers to kidney transplants that affect veterans and non-veterans alike. 

"Some veterans may face additional challenges as a result of their service,” said Dr. Mohottige. “Homelessness, post-traumatic stress disorder, and exposure to hazardous materials can affect a veteran’s kidney function or ability to receive care."

According to the VA,^3,4,5 

• Over 35,000 veterans experienced homelessness in January 2023.
• Veterans are more likely to experience PTSD, which may be related to poor physical health.
• Chemical or hazardous material exposure may damage the kidneys.

Moved by her experience, Dr. Mohottige continued working with the VA system after graduation. Her goal? To make kidney transplants more accessible for veterans. 

Are you a veteran looking for a living kidney donor? Learn about Donor Outreach for Veterans.

Improving the healthcare system

Dr. Mohottige puts empathy at the core of improving how the healthcare system serves veterans. She firmly believes the first step to improving the system is to understand what veterans experience during their service on an individual level.

“With this information, we can better equip veterans to reenter civilian life. We can help them find a job, navigate the healthcare system, and get mental health support," Dr. Mohottige said. "Luckily, the VA has many support services to help improve outcomes.”

Veteran resources:

• National Call Center for Homeless Veterans: 1-877-424-3838. Press 1. Available 24/7.
• Veterans Crisis Line: Dial 988 and press 1 or text 838255. Available 24/7.
• Women Veterans Call Center: 1-855-VA-Women (1-855-829-6636). Available from 8 AM to 10 PM ET Monday through Friday or Saturday from 8 AM to 6:30 PM ET. 
• Veteran Caregiver Support: Call 1-855–260–3274. Available Monday through Friday between 8 AM to 8 PM ET.

Find more veteran resources. 

“There are many systems within the VA I wish we could roll out to the civilian healthcare system. Private insurance companies can deny people preventative care. VA patients always receive the medication they need,” Dr. Mohottige said. “Our system is centralized. We have all the patient's records no matter which facility they use."

What Dr. Mohottige thinks the VA can improve is its education.

“High-quality education across centers would ensure people understand their care options. I share NKF resources with my veterans and would love to see these shared more,” said Dr. Mohottige. “We also need to train providers in culturally competent care. The better we understand the barriers people face, the better we can help them overcome them.”

NKF is here to help no matter where you are on your kidney journey. Get started at the Kidney Learning Center for free kidney health courses.

Sources
¹“Support for Veterans with Kidney Disease.” VA News, 17 May 2023, news.va.gov/119226/support-for-veterans-with-kidney-disease/.
²Butler CR, Wightman A, Richards CA, et al. Thematic Analysis of the Health Records of a National Sample of US Veterans With Advanced Kidney Disease Evaluated for Transplant.
³VA Homeless Programs.” Point-in-Time (PIT) Count, US Department of Veteran Affairs, 3 Jan. 2024, www.va.gov/homeless/pit_count.asp. 
⁴“Veterans Affairs.” PTSD and Physical Health, Va.gov, 16 Aug. 2018, www.ptsd.va.gov/professional/treat/cooccurring/ptsd_physical_health.asp. 
⁵“Exposure to Burn Pits and Other Specific Environmental Hazards.” Specific Environmental Hazards , Veterans Affairs, www.va.gov/disability/eligibility/hazardous-materials-exposure/specific-environmental-hazards/. Accessed 9 Apr. 2024.