Kidney donation and transplantation in Australia: more than a supply and demand equation

The Australian organ allocation system relies on equity and maximising effectiveness, but these are sometimes difficult to reconcile

Donated kidneys are scarce and valuable, generously supplied by living donors or altruistically after death. Access to the Australian kidney transplant waiting list requires individuals with end-stage kidney disease to be eligible for Medicare and accepted by a transplant program through meeting the medium to long term life expectancy eligibility criteria from the Transplantation Society of Australia and New Zealand (TSANZ).1 There are state by state and transplant unit specific approaches to listing based on geography and population variability.2 The current overall Australian 5-year kidney transplant recipient survival rate is about 90%, with 5-year kidney survival at about 80%,3 as reported through the Australia and New Zealand Dialysis and Transplant Registry.4 There is, on average, a five- to ten-fold reduction in mortality for patients who have received a kidney transplant compared with those who remain on dialysis, explaining the continued demand for kidneys for transplantation.5