Stephen P McDonald AM, Katie Cundale, Christopher E Davies, Kelli Karrikarringka Owen (Kaurna, Nharangga, and Ngarrindjeri), Kerry Dole, Feruza Kholmurodova, Matilda D’Antoine (Paakantyi), Jaquelyne T Hughes (Wagadagam)
{"title":"我在名单上吗？在土著和托雷斯海峡岛民肾衰竭患者中，临床报告的肾移植非等候因素：一项横断面研究","authors":"Stephen P McDonald AM, Katie Cundale, Christopher E Davies, Kelli Karrikarringka Owen (Kaurna, Nharangga, and Ngarrindjeri), Kerry Dole, Feruza Kholmurodova, Matilda D’Antoine (Paakantyi), Jaquelyne T Hughes (Wagadagam)","doi":"10.5694/mja2.52698","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>To describe clinician-reported reasons for non-waitlisting of patients with kidney failure for deceased donor kidney transplantation, and to examine disparities affecting Aboriginal and Torres Strait Islander people.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Retrospective cross-sectional analysis of data from a national clinical quality registry.</p>\n </section>\n \n <section>\n \n <h3> Participants and setting</h3>\n \n <p>Patients receiving dialysis in 26 Australian renal units as of 31 December 2020.</p>\n </section>\n \n <section>\n \n <h3> Main outcome measures</h3>\n \n <p>Rates of active waitlisting for kidney transplantation and clinician-reported reasons for non-waitlisting.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Thirty-six of 1832 Aboriginal and Torres Strait Islander people (2.0%) were actively waitlisted, compared with 512 of 6128 non-Indigenous people (8.4%). For Aboriginal and Torres Strait Islander patients aged < 65 years, 457 of 1204 (38%) were not waitlisted due to a permanent contraindication, 276 (23%) due to a temporary contraindication, and 232 (19%) due to incomplete work-up. Among those with a contraindication, cardiovascular disease was reported as the reason for about a quarter of people in both groups. Obesity was cited for 163 Aboriginal and Torres Strait Islander patients aged < 65 years (22%) and 30 Aboriginal and Torres Strait Islander patients aged ≥ 65 years (10%); in the non-Indigenous group, obesity was cited for 207 (26%) and 163 (9%) patients aged < 65 years and ≥ 65 years, respectively. Cancer was reported for 28 Aboriginal and Torres Strait Islander patients aged < 65 years (4%) and 86 non-Indigenous patients aged < 65 years (11%). Other reasons for non-waitlisting, reported as free text, included patient safety, smoking, age and mental health.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Aboriginal and Torres Strait Islander people experience inequities in waitlisting for kidney transplantation across multiple stages of a complex process. Addressing these barriers requires system-level reform and accountability to improve equity in transplantation access.</p>\n </section>\n </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 1","pages":"46-53"},"PeriodicalIF":8.5000,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52698","citationCount":"0","resultStr":"{\"title\":\"Am I on the list? 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For Aboriginal and Torres Strait Islander patients aged < 65 years, 457 of 1204 (38%) were not waitlisted due to a permanent contraindication, 276 (23%) due to a temporary contraindication, and 232 (19%) due to incomplete work-up. Among those with a contraindication, cardiovascular disease was reported as the reason for about a quarter of people in both groups. Obesity was cited for 163 Aboriginal and Torres Strait Islander patients aged < 65 years (22%) and 30 Aboriginal and Torres Strait Islander patients aged ≥ 65 years (10%); in the non-Indigenous group, obesity was cited for 207 (26%) and 163 (9%) patients aged < 65 years and ≥ 65 years, respectively. Cancer was reported for 28 Aboriginal and Torres Strait Islander patients aged < 65 years (4%) and 86 non-Indigenous patients aged < 65 years (11%). 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Am I on the list? Clinician-reported factors for kidney transplantation non-waitlisting among Aboriginal and Torres Strait Islander people with kidney failure: a cross-sectional study
Objectives
To describe clinician-reported reasons for non-waitlisting of patients with kidney failure for deceased donor kidney transplantation, and to examine disparities affecting Aboriginal and Torres Strait Islander people.
Design
Retrospective cross-sectional analysis of data from a national clinical quality registry.
Participants and setting
Patients receiving dialysis in 26 Australian renal units as of 31 December 2020.
Main outcome measures
Rates of active waitlisting for kidney transplantation and clinician-reported reasons for non-waitlisting.
Results
Thirty-six of 1832 Aboriginal and Torres Strait Islander people (2.0%) were actively waitlisted, compared with 512 of 6128 non-Indigenous people (8.4%). For Aboriginal and Torres Strait Islander patients aged < 65 years, 457 of 1204 (38%) were not waitlisted due to a permanent contraindication, 276 (23%) due to a temporary contraindication, and 232 (19%) due to incomplete work-up. Among those with a contraindication, cardiovascular disease was reported as the reason for about a quarter of people in both groups. Obesity was cited for 163 Aboriginal and Torres Strait Islander patients aged < 65 years (22%) and 30 Aboriginal and Torres Strait Islander patients aged ≥ 65 years (10%); in the non-Indigenous group, obesity was cited for 207 (26%) and 163 (9%) patients aged < 65 years and ≥ 65 years, respectively. Cancer was reported for 28 Aboriginal and Torres Strait Islander patients aged < 65 years (4%) and 86 non-Indigenous patients aged < 65 years (11%). Other reasons for non-waitlisting, reported as free text, included patient safety, smoking, age and mental health.
Conclusions
Aboriginal and Torres Strait Islander people experience inequities in waitlisting for kidney transplantation across multiple stages of a complex process. Addressing these barriers requires system-level reform and accountability to improve equity in transplantation access.
期刊介绍：
The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.
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