The kidney cut-off: Why First Nations patients aren’t making the transplant list

Access to kidney transplantation continues to highlight significant disparities, particularly affecting Aboriginal and Torres Strait Islander populations who face a four-to-five times higher burden of kidney failure. Despite being recognised as the optimal treatment enhancing both quality and length of life, the First Nations communities experience lower access compared to non-Indigenous Australians.

This NAIDOC Week (6–13 July), new research from the National Indigenous Kidney Transplantation Taskforce (NIKTT) delivers a national first: a comprehensive breakdown of clinician-reported reasons behind why patients are not being waitlisted. The findings from 26 renal units expose not just gaps in care, but systemic failures that continue to disadvantage First Nations peoples at every stage of the transplant journey.

Data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) confirms that once patients with kidney disease are on the wait list, the time to transplantation is similar across the board. But the real inequity lies earlier: in the hurdles to achieving active waitlisting status.

The report makes it clear that the barriers emerge from the outset. From patients never receiving assessments, to being declared ineligible after prolonged delays, First Nations patients are disproportionately caught in a web of systemic inertia. Even when clinical factors such as cardiovascular disease or obesity appear at comparable rates, it is the accumulation of disrupted and delayed care that continues to shut the door on eligibility and equitable access to transplantation.

“Addressing such barriers to improve access to transplantation requires not only recognising and dismantling structural contributors to inequity, but also supporting clinicians to critically reflect on their and their colleagues’ own practices. For patients, it is the clinician’s responsibility to not accept racist practices on their behalf.

“For clinicians, it is our responsibility as a health care community with integrity to actively challenge and reform discriminatory systems so that racism in care is identified, addressed and disrupted through action and accountability,” the authors urged.

Their call to action is unequivocal: systemic, targeted investment is urgently needed to reform referral pathways, streamline assessment processes, and deliver culturally safe care in kidney disease.

The study findings not only validate concerns long raised by communities and advocates, they also strengthen the case for long-term funding to implement Priority 2 of the National Strategy for Organ Donation, Retrieval and Transplantation, which is focused on closing the transplant equity gap for First Nations people.

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