Am I on the list? Clinician‐reported factors for kidney transplantation non‐waitlisting among Aboriginal and Torres Strait Islander people with kidney failure: a cross‐sectional study

Authors:
Open Access
Publisher website
Google Scholar
Abstract
Objectives: To describe clinician‐reported reasons for non‐waitlisting of patients with kidney failure for deceased donor kidney transplantation, and to examine disparities affecting Aboriginal and Torres Strait Islander people.Design: Retrospective cross‐sectional analysis of data from a national clinical quality registry.Participants and setting: Patients receiving dialysis in 26 Australian renal units as of 31 December 2020.Main outcome measures: Rates of active waitlisting for kidney transplantation and clinician‐reported reasons for non‐waitlisting.Results: Thirty‐six of 1832 Aboriginal and Torres Strait Islander people (2.0%) were actively waitlisted, compared with 512 of 6128 non‐Indigenous people (8.4%). For Aboriginal and Torres Strait Islander patients aged < 65 years, 457 of 1204 (38%) were not waitlisted due to a permanent contraindication, 276 (23%) due to a temporary contraindication, and 232 (19%) due to incomplete work‐up. Among those with a contraindication, cardiovascular disease was reported as the reason for about a quarter of people in both groups. Obesity was cited for 163 Aboriginal and Torres Strait Islander patients aged < 65 years (22%) and 30 Aboriginal and Torres Strait Islander patients aged ≥ 65 years (10%); in the non‐Indigenous group, obesity was cited for 207 (26%) and 163 (9%) patients aged < 65 years and ≥ 65 years, respectively. Cancer was reported for 28 Aboriginal and Torres Strait Islander patients aged < 65 years (4%) and 86 non‐Indigenous patients aged < 65 years (11%). Other reasons for non‐waitlisting, reported as free text, included patient safety, smoking, age and mental health.Conclusions: Aboriginal and Torres Strait Islander people experience inequities in waitlisting for kidney transplantation across multiple stages of a complex process. Addressing these barriers requires system‐level reform and accountability to improve equity in transplantation access.
Funding Information
  • Department of Health and Aged Care, Australian Government (4‐BIA3J8Y)

This publication has 26 references indexed in Scilit: