Geographic variance in access to renal transplantation in Australia

Abstract

<h4>Background</h4>Geographic disparities in access to transplantation in Australia during the past 15 years have been accentuated by the increasing size of the transplant waiting lists in each state and by low cadaveric donation rates. Access to dialysis treatment is similar in all states of Australia, although there are fewer elderly dialysis patients in South Australia.<h4>Results</h4>Access to the transplant waiting list varies significantly between the states, with one state having 39 per million population (pmp) on their list compared with the two most populous states at 113 pmp and 101 pmp. Patients between the ages of 25 and 54 years in one state had twice the chance of being on the waiting list compared with another. Transplantation rates reflect both the cadaveric donor rate (16.9 transplants pmp) and the large contribution from living donors (39% of all transplants in 2001). Transplantation with a kidney in Australia is dependent both upon age and the state of residence, with one state performing transplantations with 15% of their dialysis population each year but all other states achieving less than 10%, with an average of 8% for the country as a whole.<h4>Conclusions</h4>Criteria for access to the transplantation waiting list in each state vary, depending perhaps upon whether a general community or individual patient perspective is the dominant policy. Access to transplantation on the other hand is reflective of each states' cadaveric donation rate modified by increasing use of living donors, especially in younger patients.