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

Abstract

Improving equity in access to kidney transplantation: implementing targeted models of care focused on improving timely access to waitlisting K idney transplantation provides better quality and quantity of life for people with kidney failure. 1 However, of the 14% of all prevalent dialysis patients who identify as Aboriginal and Torres Strait Islander within the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, only 2% were waitlisted in 2021, compared with 8% of non-Indigenous patients who were waitlisted. 2 Equitably addressing this waitlisting gap was a significant priority of the National Indigenous Kidney Transplant Taskforce (NIKTT). 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. These sponsorship projects were pilots of local care delivery that aimed to overcome context-specific barriers to kidney transplantation waitlisting. A more detailed evaluation of each of these projects will be available in the NIKTT's final report. 10 Here, we provide a commentary on elements of each project that acted as enablers or challenges, to better understand what could be scaled or used to improve services in the future. We outline the strategies used to overcome barriers, what was learned from the projects, and the implications for further practice change.

Kidney transplantation access and outcomes for Aboriginal and Torres Strait Islander children and young adults, 1963–2020: an ANZDATA registry study

“…Proactively responding to factors that lead to graft loss and involve medical non‐adherence is consequently crucial for supporting graft and recipient survival, 32‐34 such as minimising the complexity of the medication regime, involving clinical pharmacists, and providing relevant educational and behavioural interventions 35 . Other strong recommendations include employing First Nations people in clinical care in transplantation units and in local care, including peer navigators who aid both health staff and families with culturally based understanding of transplantation care, 36 and improving family understanding and ability to participate in living organ donation 37 …”