Access to the kidney transplant waiting list: a time for reflection

Area of Science:

• Nephrology
• Transplantation Medicine
• Public Health Policy

Background:

• Limited deceased donor kidney availability in Australia is a significant concern.
• The current renal transplant waiting list may not accurately reflect true demand.
• Dialysis patient wait-listing for kidney transplantation is low and declining.

Purpose of the Study:

• To analyze Australian registry data on renal transplant waiting lists.
• To identify reasons for the under-representation of demand on the waiting list.
• To propose improvements to kidney transplant eligibility criteria.

Main Methods:

• Analysis of Australian national registry data.
• Examination of trends in dialysis patient wait-listing over time.
• Comparative analysis of wait-listing across Australian states and territories.

Main Results:

• A very low proportion of dialysis patients are wait-listed for kidney transplants.
• The percentage of wait-listed dialysis patients has decreased across Australia.
• Significant geographical variations exist in patient wait-listing numbers.

Conclusions:

• The renal transplant waiting list under-represents actual demand for kidney transplants in Australia.
• Reasons for low and declining wait-listing require further investigation.
• New, transparent, and justifiable eligibility criteria are needed to balance equity and utility in kidney transplantation.