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Calls to review kidney transplant policy

Australian dialysis patients are not signing up for kidney transplants and the waiting list has shrunk, despite a rise in kidney disease, new research shows.

Kidney waiting list guidelines need to be overhauled to address the low number of Australian patients signed up for transplants, experts say.

Australia bucks the trend of other western countries when it comes to the proportion of dialysis patients who are on a transplant waiting list.

Only 18 per cent of Australian dialysis patients aged under 65 are on a waiting list for a transplant, compared to 48 per cent in the United Kingdom, 49 per cent in France and 33 per cent in the United States.

Professor Bruce Pussell from Sydney's Prince of Wales Hospital said there is a very low proportion of Australian dialysis patients on the transplant waiting list across all age groups.

The number of people listed as waiting has also fallen over the past five years, despite the rising number of people on dialysis.

This is also despite the fact transplant recipients experience lower mortality rates compared to those left on dialysis, in every age group, he said.

Pussell has authored a study, published in the April edition of the Internal Medicine Journal of the Royal Australasian College of Physicians, calling for a shift in the way patients are considered for the kidney transplant waiting list.

The study also showed a wide variation in the percentage of people on waiting lists in different states and territories.

Pussell said an independent review is needed to find out why people aren't signing up for kidney transplants and why the figures vary so much across the country.

"Is it that the local kidney doctors are determining who should be on it and who shouldn't be on it and that determination varies from state to state according to their own judgments, rather than looking at the possibility that everyone can benefit from a transplant?" he said.

Of just over 10,000 Australians on dialysis as at December, 2009, only about 11 per cent were on the transplant waiting list.

Under current national transplant waiting list guidelines, a person must have an 80 per cent chance of surviving at least five years after a transplant to be considered. But Pussell said the guidelines are too vague.

"The reasons that are being applied at the moment are unknown and loose. It needs to be uniform across the country and there ought to be a review of those guidelines by an independent body and community involvement so that we all know exactly where we stand in terms of putting people on the waiting list," he said.

"Surely as a nation we should have some common approach so we're treated fairly no matter where we live."


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