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Equity of access to renal transplant waiting list and renal transplantation in Scotland: cohort study

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7426.1261 (Published 27 November 2003) Cite this as: BMJ 2003;327:1261
  1. Gabriel C Oniscu, specialist registrar1,
  2. Annemarie A H Schalkwijk, research assistant2,
  3. Rachel J Johnson, principal statistician3,
  4. Helen Brown, senior statistician4,
  5. John L R Forsythe, consultant surgeon (john.forsythe{at}luht.scot.nhs.uk)1
  1. 1Transplant Unit, New Royal Infirmary of Edinburgh, Edinburgh EH16 4SA
  2. 2Scottish Renal Registry, Glasgow Royal Infirmary, Glasgow G4 0SF
  3. 3United Kingdom Transplant, Stoke Gifford, Bristol BS34 8RR
  4. 4Information and Statistics Division, Scottish National Health Service, Edinburgh EH5 3SQ
  1. Correspondence to: J L R Forsythe
  • Accepted 4 September 2003

Abstract

Objective To examine the access to the renal transplant waiting list and renal transplantation in Scotland.

Design Cohort study.

Setting Renal and transplant units in Scotland.

Participants 4523 adults starting renal replacement therapy in Scotland between 1 January 1989 and 31 December 1999.

Main outcome measures Impact of age, sex, social deprivation, primary renal disease, renal or transplant unit, and geography on access to the waiting list and renal transplantation.

Results 1736 of 4523 (38.4%) patients were placed on the waiting list for renal transplantation and 1095 (24.2%) underwent transplantation up to 31 December 2000, the end of the study period. Patients were less likely to be placed on the list if they were female, older, had diabetes, were in a high deprivation category, and were treated in a renal unit in a hospital with no transplant unit. Patients living furthest away from the transplant centre were listed more quickly. The only factors governing access to transplantation once on the list were age, primary renal disease, and year of listing. A significant centre effect was found in access to the waiting list and renal transplantation.

Conclusions A major disparity exists in access to the renal transplant waiting list and renal transplantation in Scotland. Comorbidity may be an important factor.

Footnotes

  • Contributors GCO designed the study with JLRF, compiled the database, performed some of the analyses, and wrote the manuscript. AHS collected the postcode data and updated the entries in the renal registry. RJJ extracted the relevant data from the UK transplant database and provided statistical advice. HB performed the statistical analyses and contributed to the statistical sections of the manuscript. JLRF designed the study with GCO and revised the manuscript; he will act as guarantor for the paper.

  • Funding GCO was funded by a grant from the Scottish Executive. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests JLRF has received both honorariums from Fujisawa, Novartis, Roche, and Wyeth for speaking at meetings or serving on advisory groups and funding for attending meetings. These companies have also supported some research by the department's research group.

  • Ethical approval This study was part of a research project that was approved by the Lothian research ethics committee (research ethics subcommittee for medical and clinical oncology; reference No LREC/2000/4/163).

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