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Despite being four to five times more likely to have kidney failure, Aboriginal and Torres Strait Islander people have much lower access to kidney transplantation that other Australians.

Of the 1832 Aboriginal and Torres Strait Islander people receiving dialysis, only 36 (two per cent) were actively waitlisted for a transplant compared with 512 of 6128 non-Indigenous people (8.4 per cent).

For the first time, a team of researchers including from the University of ���˲�Ʊ, have analysed the reasons why clinicians have not put Aboriginal and Torres Strait Islander people on a wait list for a kidney transplant.

The research team, including Professor Stephen McDonald, Director of the ���˲�Ʊ EpiCentre, and Aboriginal Kidney Care Improving Outcomes Now (AKction) Chief Investigator Kelli Owen, surveyed 26 renal units across Australia in 2020.

“A transplant is the optimal treatment for kidney failure and it significantly enhances both quality and quantity of life,” says Professor McDonald.

“Transplantation is a complex process for both patients and the health care system, as it depends on a series of decisions that confirm the patient–clinician acceptability based on multiple health care assessments.

Achieving active waitlisting is a good litmus test of a patient’s health, strength of patient-clinician partnerships and the performance of an equitable health care system, particularly in the context of the structural inequities imposed through the ongoing impacts of colonisation, racism and intergenerational trauma, Professor McDonald said.

“About 38 per cent of First Nations people under the age of 65 were not waitlisted due to a permanent contraindication, with cardiovascular disease accounting for about a quarter of people,” says Professor McDonald.

“Obesity, cancer, patient safety, smoking, age and mental health were also listed as reasons for both groups, but there were more limitations placed on Aboriginal and Torres Strait Islander people.

“There were similar number of Aboriginal and Torres Strait Islander and non-Indigenous people who were not waitlisted because of the cardiovascular disease and obesity, but the impact of this is higher on the First Nations group given their overall higher prevalence of non-waitlisting.

“Addressing these inequities requires targeted equity-enabling efforts to streamline and expedite work-up processes, implementing culturally safe care and structural reform.

“Governments and care providers face a cogent opportunity to prioritise practice change and structural reform that effectively manages and mitigates these barriers, ensuring culturally safe and equitable access to care.”

The research was led by the National Indigenous Kidney Transplantation Taskforce, where Professor McDonald is Co-Chair, and also featured academics from Flinders University, Northern Territory Department of Health and the Royal Darwin Hospital.

It was published in the s Special Issue on Indigenous Health for NAIDOC Week.