Access to living donor transplantation for Aboriginal recipients: a study of living donor presentation and exclusion

Aboriginals experience high rates of end-stage renal disease (ESRD) and are less likely to receive a kidney transplant from a living donor. We hypothesized that higher rates of hypertension and diabetes in Aboriginal communities would result in fewer potential living donors coming forward and more exclusions for medical reasons. We performed a retrospective study to examine the frequency of potential donor presentation and the reasons for donor exclusion among Aboriginal and Caucasian wait-listed ESRD patients at our center. Three hundred and eighty-five wait-listed patients were studied, including 174 Aboriginals and 211 Caucasians. Time on the waiting list was similar between groups. A similar proportion of Aboriginals and Caucasians had at least one potential donor (40% vs. 46%), and the rate of donor exclusion for medical reasons was also similar (23% vs. 21%). Potential donors to Aboriginals were more likely to be excluded for non-medical reasons (50% vs. 30%; p < 0.0001), of which 96% were because of loss of contact. Waitlisted Aboriginal ESRD patients appear just as likely as Caucasians to have potential living donors initiate evaluation and have a similar rate of donor exclusion because of medical reasons. Further work is required to identify why donors to Aboriginals are more likely to withdraw from the evaluation process.