June 17, 2025
Patients receiving solid organ transplants at Mayo Clinic in Arizona benefit from a patient navigator program supporting Native American and Alaska Native patients. Silena A. Thomas, a patient navigator, and David M.H. Chascsa, M.D., a transplant hepatologist, discuss this innovative program and how it is supporting Native American communities.
Patient navigator
A patient navigator at Mayo Clinic in Arizona, Silena A. Thomas supports Native American communities.
Improving access for Native American transplant patients
While Native American patients face numerous hurdles in receiving healthcare, Mayo Clinic's transplant patient navigator program is lowering barriers to care for Native American transplant patients. Thomas, a dedicated patient navigator, works with patients, collaborates with care teams and identifies resources to ease the transplant journey.
When new patients are referred for a transplant, Thomas makes an introductory phone call, talks through appointments and gives a basic description of the campus. Once patients are on campus, Thomas meets with them and offers a tour of the campus. She collaborates with the entire transplant care team and other Mayo staff, including social workers, to create the best experience for patients.
"There is not a lot of education about transplant in these communities," says Thomas. "When I call patients about their referrals, I want to make sure they have a primary care physician, and the support of family and friends, and that they understand their treatment schedule. I ask who they are coming with, how they are getting here, where they are staying, and if they need support."
Some patients require more help than others, but Thomas regularly checks in on everyone. She asks how their evaluations are progressing and if they need any support, especially if they need care coordinated outside Mayo Clinic, such as laboratory tests or primary care appointments.
"I like to be out in the community so patients and physicians know I'm here," Thomas says. "It makes them feel better when they know they can call me and ask for help."
Overcoming barriers to transplant care
Language can be a challenge for some Native American patients and can cause difficulty in understanding medical terms. These concerns can be compounded for transplant care since one of the requirements of being listed for transplant is the ability to adhere to a complex medical regimen that can include visits to subspecialists, notes from doctors and more. This requirement can be difficult for some patients and lead to delays in care.
Through interpretation services, Thomas is helping patients better understand care plans, instructions and recommendations.
"Overcoming this barrier increases compliance and understanding," says Dr. Chascsa. "This challenge in communicating might come across as nonadherence when it's really the difficulty of navigating a complex system. That's one of the unique benefits of Silena's role."
Thomas helps patients overcome these barriers by working with them and with care coordinators and primary care physicians. She makes sure everyone understands the care plan and what needs to be done.
Coordination throughout the transplant process
Alcohol-related liver disease is one of the top reasons for liver transplant but is a highly stigmatized condition within the Native American community. Given many of the recommendations for transplant, including specialist care, sobriety and social support, many physicians mistakenly believe that this diagnosis is a hard barrier to transplant.
However, as Dr. Chascsa says, there are no hard-and-fast guidelines for many of these conditions and the transplant team works with patients to ensure they get the care they need.
"We have protocols to get these patients through transplant, and we can benefit patients if we provide them adequate support like patient navigation," says Dr. Chascsa. "We want to open the door to discuss difficult clinical scenarios so we can hopefully offer lifesaving transplants for these patients."
Advancing outcomes for patients and communities
In addition to supporting transplant patients directly, Thomas travels to Tribal communities. She meets with healthcare center leadership and shares information about support for transplant services and how they can streamline the referral process.
"Patients and their doctors have to know they can come to Mayo Clinic because it is a safe place to receive care and they will be supported throughout this journey," says Dr. Chascsa.
Three years into the patient navigator program, the team is beginning to see data that long-term survival for Native American patients supported with these services is improving and on par with other patient groups.
"While we are just now hitting the point where we can begin analyzing data, we are seeing some exciting signals," says Dr. Chascsa. "We've seen a 50% increase in referral volume, specifically referrals of Native American patients. On a personal level, that's because of Silena's engagement since community members are reaching out to us to learn more."
For more information
Physicians can request patient navigation support when referring patients to Mayo Clinic.
Refer a patient to Mayo Clinic.