The Medical journal of Australia · 2025
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.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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McDonald Am Stephen P, Cundale Katie, Davies Christopher E, Owen Kaurna Nharangga And Ngarrindjeri Kelli Karrikarringka, Dole Kerry, Kholmurodova Feruza, D'Antoine Paakantyi Matilda, Hughes Wagadagam Jaquelyne T
Аннотация
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.
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.