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.

Overview

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.