Maximising access to kidney transplantation: A single-centre audit of people receiving dialysis

Despite transplantation being well documented as the renal replacement therapy option that gives the best morbidity and mortality outcomes, the best quality of life and the best value for healthcare dollar, not all patients are on a kidney transplant waiting list.

The aims of this study were (1) to explore possible reasons for a demonstrated a higher rate of people being listed as suitable for transplant in a non-transplanting unit and (2) to describe a formal process of review and referral as a method for maximising the number of people gaining access to the transplant waiting list.

We prospectively audited all patients who were undergoing dialysis in our metropolitan, non-transplanting renal unit annually over six years to determine whether not being on the transplant waiting list was in keeping with available eligibility guidelines of medical and behavioural criteria.

In every age group, the percentage of patients listed for transplant was higher than that seen in national data. The most common reasons for people not to be listed were malignancy, obesity and cardiovascular disease. This unit's patients had fewer smokers, less females and less Aboriginal and Torres Strait Islanders which may have contributed towards a higher rate of activation on the list.

In this dialysis patient population having a formal process of review for suitability and referral, as well as a specialist renal transplant coordinator nurse positively affected the number of patients being activated on the transplant waiting list.