Supporting equitable access to kidney transplant in remote Western Australia using continuous quality improvement

Area of Science:

• Nephrology
• Transplantation Immunology
• Public Health

Background:

• End-stage kidney disease disproportionately affects Australian Aboriginal and Torres Strait Islander populations.
• Significant disparities exist in access to kidney transplantation for these communities.
• Suitability assessment is a critical initial step in the kidney transplant pathway.

Purpose of the Study:

• Implement a continuous quality improvement (CQI) approach for transplant suitability assessment.
• Assess all patients within an Aboriginal Community Controlled renal service.
• Identify temporary contraindications to guide health service improvements.
• Explore patient experiences with the suitability assessment process.
• Inform pre- and post-transplant care models for Kimberley Renal Services.

Main Methods:

• Mixed methods design incorporating file review.
• Descriptive analysis of transplant suitability assessment results.
• Semi-structured interviews with thematic analysis of participant experiences.

Main Results:

• 30% of assessments showed no contraindications; 64% had temporary contraindications; 6% had permanent contraindications.
• Most common temporary contraindications included smoking (23/46), treatment adherence (17/46), and high BMI (11/46).
• Patients desired more information and support for modifiable risk factors to enhance transplant eligibility.

Conclusions:

• A CQI approach successfully increased suitability assessments and identified key barriers for Aboriginal patients.
• Findings underscore the need for culturally appropriate education and support involving Aboriginal staff and patients.
• Addressing modifiable factors is essential to improve waitlisting and transplant access.