A ATKINSON1, S FORD1, H GOCK1, F IERINO1, D GOODMAN1
1St Vincent’s Hospital Melbourne, Fitzroy, Australia
Background: While Indigenous Australians represent 11.3% of the dialysis population, less than 10% receive kidney transplants.
Aim: To identify the barriers to Indigenous Australians gaining access to renal transplant waiting list and provide data to guide pre-transplant health services
Methods: Indigenous patients on dialysis (n=12) or previous dialysis (n=13) with kidney transplants (n=7) were studied. Information was derived from medical records and interviews.
Results: Twelve indigenous patients of 303 dialysis patients (3.9%) with a mean age of 59 years (range 39-80), 6 male & 6 females, 6 from Melbourne & 6 country Victoria, were studied. Mean dialysis time of 5.5 years (range 20 months-11.5 years). Co-morbidities include 10 of 12 with diabetes mellitus, ischaemic heart disease (4), ex-IVDU (4), depression (3), schizophrenia (1), BMI >35 (4), foot ulceration (1), bacterial endocarditis (1), and recent colon cancer (1). One patient, a smoker/drug user regularly misses dialysis, 1 had previously been on the active list, 1 patient declined transplant work up. Seven of 265 kidney transplant recipients over the past 10 years (2.6%) waited on average 4.5 years from dialysis commencement to transplantation. Over a period of 6 years, 13 Aboriginal dialysis patients died, cardiac related (3), cerebrovascular disease (1), unknown (2). 6 of 13 were <65 years with only 1 having tissue typing completed.
Conclusions: Medical co-morbidities are the main barrier to transplant listing. Indigenous patients, once listed, had a short waiting time due to accumulated “waiting time”. Our study supports the need for establishing a multi-disciplinary group comprising doctors, nurses, aboriginal liaison officers, social workers and local health providers to help overcome the barriers in a more culturally sensitive manner and potentially improve outcomes.
An Indigenous registered nurse from country Victoria, Amy followed in her mothers footsteps of nursing.
Due to a family members health problems, dialysis sparked an interest for Amy who has since gained 4 years dialysis experience.
This research project has provided an opportunity to assist and make a difference in Indigenous health.