OVERCOMING BARRIERS FOR INDIGENOUS AUSTRALIANS GAINING ACCESS TO THE KIDNEY TRANSPLANT LIST

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.


Biography:
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.

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The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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