S MCDONALD1, K DOLE2, P BOAN3,4, W LIM5,6, S CHERIAN7,8, A ABEYARATNE9,10
1National Indigenous Kidney Transplantation Taskforce, South Australian Health and Medical Research Institute, Adelaide, Australia, 2Renal Home Therapies, Top End Health Service, Tiwi, Australia, 3Infectious Diseases Department, Fiona Stanley Hospital, Murdoch, Australia, 4Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, Australia, 5Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia, 6Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia, 7Central Australian Renal Services, Alice Springs, Australia, 8Flinders University, Adelaide, Australia, 9Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Australia, 10Flinders Medical School, Flinders University, Darwin, Australia
Aim: To identify measurable and modifiable targets at the individual and health service level that predict pre-transplant outcomes, in particular waitlisting, and establish a consistent framework for collecting and reporting data on access to transplantation.
Background: There is a significant and persistent disparity between Indigenous and non-Indigenous Australians in the access to kidney transplantation. In 2018, 87% of Indigenous patients with ESKD were maintained on dialysis and 13% had received a kidney transplant. In comparison, 49% of non-Indigenous patients were maintained on dialysis and 51% had received a kidney transplant. Prior to the NIKTT establishing this project, the ANZDATA registry did not capture reasons for patients not being waitlisted for deceased donor transplants, limiting our understanding of inequities in access to transplantation.
Methods: The NIKTT commissioned the ANZDATA registry to deliver a pilot project involving the collection and analysis of additional pre-transplant data points from 29 Australian renal units. The framework comprises two components: an annual survey and real-time reporting. The survey asks units to report on whether the patient is in active workup for transplantation, already on the waitlist, or ineligible for transplantation and the reason why. The real-time reporting component asks units to document the date of four key events as they occur: determination of eligibility for transplantation, commencement of workup, completion of workup and completion of transplant assessment.
Results & Conclusions: The findings from this project will generate valuable insights into barriers that inhibit Indigenous patients from achieving transplant waitlisting, catalysing the development of new models of care to better support Indigenous patients throughout the pre-transplant journey.
Based at the Royal Adelaide Hospital, Stephen McDonald is Director of Dialysis and a Senior Staff Nephrologist at The Central Northern Adelaide Renal and Transplantation Service and Clinical Director of Renal Services for Country Health SA Health. Stephen also serves as Executive Officer of the Australia and New Zealand Dialysis and Transplant Registry, Chair of the National Indigenous Kidney Transplantation Taskforce, and holds academic status as Clinical Professor in the Department of Medicine of the University of Adelaide.