Examining barriers to timely waitlisting for kidney transplantation for Indigenous Australians in Central Australia

Abstract

Background: Indigenous Australians are disproportionately affected by end stage kidney disease. Despite this, they face significant delays being assessed and waitlisted for kidney transplant.Aims: To examine the kidney transplant waitlisting process in our region, to compare the workup process between Indigenous Australians and non-Indigenous patients, and identify major sources of delay.Methods: We analysed the records of all patients being treated by our service who were on the kidney transplant waitlist between January 2017 and June 2018. Between-group differences were used to compare the time between commencement of dialysis and completion of each component of assessment. Patients who had more than 1 year between commencement of dialysis and waitlisting were further analysed for major sources of delay.Results: Twenty-five patients were included (20 Indigenous Australians and 5 non-Indigenous). The median time to waitlisting for transplant after commencing dialysis was significantly longer in the Indigenous group (1215 vs 264 days, P = 0.032). Indigenous Australian patients waited longer before commencing the transplant assessment process and before completing dental assessment, tissue typing and review by the transplant nephrologist and surgeon. Five patients (two Indigenous Australians, three non-Indigenous) were waitlisted within 1 year of commencing dialysis. Among the remaining 20 patients, cardiac and systems issues were the two most common major sources of delay. Conclusion:Indigenous Australian patients face significant delays accessing the kidney transplant waitlist. Cardiac assessment and systems issues are prominent sources of delay and efforts to address these areas may help to improve equity of access to kidney transplantation.

Mitigating Health Disparities in Transplantation Requires Equity, Not Equality

“…32 Canadian Aboriginal patients have a 54% lower likelihood of being active on the waiting list, 33 and Indigenous patients in Canada and Australia have longer workup and time to listing than non-Indigenous patients. 33,34 Other factors associated with a lower likelihood of waitlisting include older age, lower income, the location of UNOS region in the southeastern United States, and public insurance. 32,[35][36][37] Analyses from the USRDS Comprehensive Dialysis Study explored whether addition of the kidney disease education benefit in Medicare Part B in 2010 was associated with kidney transplant listing.…”

“…32 Canadian Aboriginal patients have a 54% lower likelihood of being active on the waiting list, 33 and Indigenous patients in Canada and Australia have longer workup and time to listing than non-Indigenous patients. 33,34 Other factors associated with a lower likelihood of waitlisting include older age, lower income, the location of UNOS region in the southeastern United States, and public insurance. 32,35-37…”

Improving equity in access to kidney transplantation: implementing targeted models of care focused on improving timely access to waitlisting

“…A significant barrier to waitlisting involves the pervasive poor communication from health systems to patients, leading to missed opportunities and culturally unsafe care. 6,[8][9]21,22 The projects proposed the development of educational sessions and resources to educate patients and care providers on transplantation in local settings.…”

“…Many barriers impede Aboriginal and Torres Strait Islander people who live with dialysis from accessing waitlisting, including slow or delayed assessments and referrals, cultural bias, misinformation, and the difficulties of distance (Box). 4‐9 …”

“…3 Many barriers impede Aboriginal and Torres Strait Islander people who live with dialysis from accessing waitlisting, including slow or delayed assessments and referrals, cultural bias, misinformation, and the difficulties of distance (Box). [4][5][6][7][8][9] The Commonwealth Department of Health and Aged Care awarded $1.3 million to the NIKTT to enable competitive project sponsorships for health care providers to develop models of care that promoted waitlisting attainment. All funded projects extended previously successful models of care to address contextspecific barriers to waitlisting and transplantation.…”