Jurisdictional inequalities in deceased donor kidney allocation in Australia

Transplant recipients generally live longer and have better overall quality of life compared with patients treated with maintenance dialysis.1 However, not all patients on dialysis waiting for a kidney transplant will enjoy the benefits of transplantation before death. The annual mortality rate on the Australian deceased donor kidney transplant waiting list is approximately 2% to 5% (varied by age of the transplant candidates), owing largely to cardiovascular-related deaths. The major impediment to transplantation is shortage of donor organs. Although there has been an increase in organ donation rate from <11 donors per million population to 21.6 donors per million population in Australia over the past decade, the number of patients on dialysis in need of transplantation has also increased substantially over time.2 Even if donation rates continue to increase, demand will likely outstrip the supply, necessitating careful attention to donation, equitable access, and allocation...