Not all doctors agree my patient deserved his new kidney. They’re wrong
Just before Christmas 2016, a 68-year old man received a kidney transplant, one of 1091 Australians that year.
However, as an Aboriginal Australian, he was one of only six over the age of 65 to receive a kidney transplant in the past 20 years. In fact, he was the second-oldest ever.
Should my patient have received a kidney? Many of my kidney specialist colleagues apparently don't think so.
Not only have some told me so, but national transplant data shows an Indigenous Australian from a remote or very remote area has only a tenth the chance of a kidney transplant as a non-Indigenous patient from the same region.
(This figure takes into account age, sex and co-existing illnesses, such as diabetes or heart disease).
Why should my patient miss out?
Why do some of my colleagues think my patient should not have received a kidney?
Australia's guidelines require that for patients to be wait-listed, they must have an anticipated 80 per cent likelihood of survival five years post-transplant. How long is a 68 year old Aboriginal man from a remote NT community likely to live, if he receives a kidney transplant?
Our recent work using transplant data from 2000 to 2012 shows the estimated survival rate after five years was 92 per cent for urban, non-indigenous Australians, but only 69 per cent for remote-origin Indigenous Australians.
Does this mean that Indigenous Australians from remote areas should not even be considered for the waiting list?
Road to transplant a "maze"
Putting this consideration aside, there are plenty more challenges on the road to a kidney transplant, which can take anywhere from a month to several years.
Patients must clear these numerous hurdles while affected by debilitating illness and the onerous requirements of dialysis several times per week.
To start with, many patients may not even be aware that a kidney transplant is possible. After expressing an interest, patients must have an arduous series of blood, heart, lung and infectious diseases tests. In many public hospitals, waiting times for these initial tests can be months. Treating and stabilising conditions often takes much longer, requiring more tests and appointments.
If the patient "passes" all these tests, they will be referred to even more specialists, whose detailed opinions are presented to a panel of other transplant specialists who together decide if the patient is suitable to be wait-listed for a transplant.
No requirement for equitable access
Threading the maze of the specialist health system while sick is daunting for anyone. But it's particularly challenging for people who are disempowered, poor, without family or community support due to a move to an urban environment, and have English as a second, third or fourth language.
Much essential knowledge is assumed rather than shared, as are resources like stable housing and ready access to transport.
Australia's organ transplant guidelines do not require that all Australians have equitable access to transplant assessment or waitlisting. In contrast, similar documents from the UK and Canada explicitly require equity of access, and also do not require a survival figure.
In short, Indigenous patients often get transplants despite the system, rather than because of it.
Since 2010, fewer than a dozen from a remote or very remote area of Australia have done so.
Indigenous patients from northern and central Australia have themselves spoken about these barriers recently: you can hear them speak.
What a new kidney can achieve in a year
In the year since his kidney transplant, my patient has been busy. He's hosted the Prime Minister and the Leader of the Opposition at the Garma Festival, signed a land lease with the Australian Government (the first to be held by an Indigenous owned and controlled entity), opened the first Aboriginal-owned mine in Australia and advanced plans to build a space port on his community's land.
In all of this he continues to be a trail blazer, building on work beginning in the 1960s that led to becoming 1978 Australian of the Year and the Chairman of the Northern Land Council for 25 years, before recommitting himself in 2005 to the future and development of his Gumatj clan.
Happy New Year, Dr Galarrwuy Yunupingu. You've beaten the odds to get this far. Long may your new kidney last.