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Objectives: To assess differences between Aboriginal and Torres Strait Islander and non‐Indigenous Australian children and young adults in access to and outcomes of kidney transplantation. Study design: A cohort study based on prospectively collected data; analysis of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Setting, participants: Children and young adults aged 0–24 years who commenced kidney replacement therapy in Australia during 1963–2020. Main outcome measures: Proportions of children and young adults who received kidney transplants within five years of commencing dialysis; 5‐ and 10‐year death‐censored graft survival; and 5‐ and 10‐year survival of children and young adults who received kidney transplants or who remained on dialysis. Results: During 1963–2020, 3736 children and young adults received kidney replacement therapy in Australia: 213 (5.8%) Aboriginal and Torres Strait Islander and 3523 (94.2%) non‐Indigenous children and young adults. During follow‐up (median, eight years; interquartile range [IQR], 2.6–15 years), 2762 children and young adults received kidney transplants: 93 Aboriginal and Torres Strait Islander (43.7% of those receiving kidney replacement therapy) and 2669 non‐Indigenous children and young adults (75.8%). Smaller proportions of Aboriginal and Torres Strait Islander than of non‐Indigenous children and young adults received transplants within five years of commencing dialysis (99, 46% v 2924, 83.0%), received living donor transplants (19, 20% v 1170, 43.9%), or underwent pre‐emptive transplantation (one, 1.1% v 363, 13.6%). Five‐year graft survival for Aboriginal and Torres Strait Islander recipients was similar to non‐Indigenous recipients (61% v 75%; adjusted hazard ratio [aHR], 1.43; 95% confidence interval [CI], 0.02–2.05), but 10‐year graft survival was lower (35% v 61%; aHR, 1.69; 95% CI, 1.25–2.28). Five‐ and 10‐year survival after kidney transplantation was similar for Aboriginal and Torres Strait Islander and non‐Indigenous people. Among those who remained on dialysis, 10‐year survival was poorer for Aboriginal and Torres Strait Islander than non‐Indigenous children and young adults (aHR, 1.50; 95% CI, 1.08–2.10). Conclusions: Five‐year graft and recipient survival were excellent for Aboriginal and Torres Strait Islander children and young adults who received kidney transplants; however, a lower proportion received transplants within five years of dialysis initiation, than non‐Indigenous children and young adults. Improving transplant access within five years of dialysis commencement should be a priority. [ABSTRACT FROM AUTHOR]

This article explores the significance of providing optimal care for Aboriginal and Torres Strait Islander peoples with kidney failure in the Northern Territory of Australia. It emphasizes the importance of addressing health disparities and cultural factors that influence health outcomes in order to improve the well-being of these communities. The article presents a case study of a Torres Strait Islander woman's health journey, highlighting the integration of traditional healing practices with biomedical approaches and the value of patient-centered care. Additionally, the article discusses the role of Storying, a method of knowledge collation and archiving in Aboriginal and Torres Strait Islander cultures, in amplifying marginalized voices and serving as an educational tool for healthcare providers and Indigenous individuals. The article underscores the significance of culturally sensitive care and patient autonomy in achieving positive health outcomes for Indigenous communities, and advocates for a model of care that prioritizes Indigenous self-determination, cultural safety, and acknowledges the social and cultural determinants of health. It also emphasizes the need for sustained support for Indigenous self-determination and the development of a diverse healthcare workforce to comprehensively address Indigenous health needs. [Extracted from the article]

Aboriginal and Torres Strait Islander kidney transplant recipients and family members - like nearly all other transplant recipients - also affirm the many health and wellbeing benefits of transplantation,[[7]] and numerous community consultations have shown that Aboriginal and Torres Strait Islander people want a better understanding of, and access to, transplantation.[9], [10], [11], [12] Disparity in access to transplantation has been recognised for many years.[13], [14], [15], [16], [17], [18] Although absolute rates of waitlisting and transplantation have increased among Aboriginal and Torres Strait Islander peoples, substantial inequity remains in rates of waitlisting and transplantation compared with non-Indigenous populations, as well as age at diagnosis, pre-transplant treatment modality, and transplantation outcomes.[2] Furthermore, the reasons behind the inequity remain. Kidney transplantation, Transplantation, Social determinants of health, Healthcare disparities, Health policy, Health systems Keywords: Kidney transplantation; Transplantation; Social determinants of health; Healthcare disparities; Health policy; Health systems EN Kidney transplantation Transplantation Social determinants of health Healthcare disparities Health policy Health systems S3 S6 4 10/17/23 20231002 NES 231002 For tens of thousands of years, Aboriginal and Torres Strait Islander people have operated and thrived within sovereign societies. [Extracted from the article]

Keywords: Kidney diseases; Kidney transplantation; Healthcare disparities EN Kidney diseases Kidney transplantation Healthcare disparities S19 S22 4 10/17/23 20231002 NES 231002 Lasting improvement in access to, and outcomes of, kidney transplantation will take sustained focus and coordinated effort. Additional aspects of the transplantation pathway, such as post-transplant care and paediatric transplantation, that were not within the scope of this iteration of the NIKTT's work must also be researched and initiatives evaluated. Combining these findings, as well as a position statement on transplantation equity[6] that was endorsed by many community and clinical members of the Taskforce and larger network, the NIKTT identified three key areas for action, and associated recommendations, to continue to improve access to kidney transplantation (Box). There will be many lessons from the transplant sector that can be taken up throughout services that care for people with chronic kidney disease, other chronic health conditions, and, more broadly, for Aboriginal and Torres Strait Islander people across Australia. [Extracted from the article]

Keywords: Kidney transplantation; Kidney diseases; Health policy; Healthcare disparities; Racism; Health services; Cultural competency EN Kidney transplantation Kidney diseases Health policy Healthcare disparities Racism Health services Cultural competency S11 S14 4 10/17/23 20231002 NES 231002 Inequities persist for Aboriginal and Torres Strait Islander people accessing health services in Australia, as evidenced by kidney health outcomes and the consistently lower rate of access to kidney transplantation experienced by Aboriginal and Torres Strait Islander people.[1] The Australian Government has endeavoured to address this persisting inequity in access to kidney transplantation by establishing the National Indigenous Kidney Transplantation Taskforce (NIKTT), and tasking them to evaluate cultural bias interventions in Australia, with a focus on kidney services. Kidney transplantation, Kidney diseases, Health policy, Healthcare disparities, Racism, Health services, Cultural competency. [Extracted from the article]

Kidney transplantation, Kidney diseases, Health systems, Health services, Consumer health information, Healthcare disparities, Holistic health Doing it right: establishing an effective Indigenous Reference Group in Adelaide At the RAH, Aboriginal and Torres Strait Islander patients come from South Australia, the Northern Territory and western New South Wales to receive kidney transplantation care. Keywords: Kidney transplantation; Kidney diseases; Health systems; Health services; Consumer health information; Healthcare disparities; Holistic health EN Kidney transplantation Kidney diseases Health systems Health services Consumer health information Healthcare disparities Holistic health S15 S18 4 10/17/23 20231002 NES 231002 Consumer engagement is invaluable for informing, and thus supporting, improvements in the quality of health care delivery by services. [Extracted from the article]

Alongside these outreach clinics, projects ran transplant education sessions for patients, communities, and health staff. Providing local, culturally relevant education to potential transplant patients led to better understanding of the complicated workup and transplant process, creating the opportunity for more patients to engage with workup while enhancing understanding of local processes. [Extracted from the article]

The Medical Journal of Australia has partnered with the Lowitja Institute, Australia's national Aboriginal Community Controlled Research Institute, to release a special issue focused on Indigenous knowledges. The collaboration aims to address the lack of Indigenous perspectives in health research and publishing practices. The special issue features 12 articles that cover a range of topics related to Aboriginal and Torres Strait Islander health and wellbeing. The journal acknowledges the need to cede power and decision-making to Indigenous experts in order to improve ethical publishing practices and promote meaningful change in Indigenous health. [Extracted from the article]

The Zenadh Health Science Research and Education Council is being established as a physical infrastructure to unite Zenadh (Torres Strait) culture with Eurocentric sciences. The Council aims to secure and maximize Zenadh knowledge and skills while incorporating Eurocentric scientific practices. It is a means for Torres Strait Islander peoples to exercise their right to free, prior, and informed consent in scientific inquiry and to promote their political autonomy and self-determination. The Council will work on various health initiatives, such as providing haemodialysis services and reducing complications of diabetes. The authors emphasize the importance of cultural protocols and language in their work and express their desire for culturally honoring supporters and enablers of their survival. [Extracted from the article]

The formation of the National Indigenous Kidney Transplantation Taskforce (NIKTT) - including a secretariat guided by the leadership of a Torres Strait woman (also a nephrologist) and a Kaurna, Narungga and Ngarrindjeri woman (also a kidney transplant recipient) - was a pivotal step in changing Australian transplantation access. Keywords: Kidney transplantation; Healthcare disparities; Kidney diseases EN Kidney transplantation Healthcare disparities Kidney diseases 356 357 2 10/17/23 20231002 NES 231002 Aboriginal and Torres Strait Islander people with chronic kidney disease seek good health, good kidney health, and good experiences of health care at all stages of their kidney journeys.[1], [2], [3] Kidney replacement therapy is crucial for people with kidney failure, so needs to be accessed regularly, safely and sustainably alongside high quality cultural and clinical support. [Extracted from the article]