First Nations Australians three times less likely to get a kidney transplant

There is a number that should be harder to ignore than it is: of First Nations Australians receiving kidney replacement therapy in 2022, just 16% had a functioning kidney transplant. The equivalent figure for non-Indigenous Australians was 48%.

That three-fold difference is not new data. It has been sitting in health system records for years. What is new this week is a documentary — In Contrast, created by Peter Crumpton, founder of The Transplant Network and a heart transplant recipient — that puts names and faces to what that statistic means for the people living inside it.

One of those people is Kelli Karrikarringka Owen, a Kaurna, Narungga and Ngarrindjeri woman and public health researcher at the University of Adelaide. She spent three years on dialysis from age 41, travelling to Adelaide regularly from her community. About ten years ago, her family offered to donate. The system refused. She eventually received a kidney from a New South Wales donor through the national program in 2016. She describes the refusal of her family’s offer as systemic racism. She would like this to stop being a silent story.

The disease is silent. The gap is not.

Chronic kidney disease is called a silent killer because it can progress — substantially — before a person feels unwell. Aboriginal and Torres Strait Islander adults are about twice as likely as non-Indigenous Australians to have it, according to federal government data. The risk factors are familiar: diabetes, high blood pressure, family history, age. But in First Nations communities, those factors are compounded by geography, access, and the downstream effects of decades of inadequate healthcare.

For many people, the point at which kidney disease becomes visible is the point at which it is already serious. Kidney replacement therapy — dialysis or transplant — becomes necessary when the kidneys can no longer manage on their own. Dialysis is life-sustaining but demanding: regular sessions, often in cities, often three times a week. A kidney transplant changes that calculus entirely. With a functioning transplant, a person has something closer to a normal life.

Which is why the gap in that 16% versus 48% figure matters so much.

Both-and: the barriers are multiple, and some are changing

Professor Janet Kelly, a nurse researcher at the University of Adelaide, has spent years working on this. Her analysis of the gap identifies layers.

Geography. About half of Aboriginal people live in rural and remote areas. Most specialist kidney services are concentrated in cities. The practical barrier of getting to those services — for regular dialysis, for transplant assessment, for post-transplant follow-up — is enormous. Visiting specialist clinics that travel to communities are a well-supported response with good data behind them. They exist in pockets. They are not the norm.

Donor eligibility guidance. Earlier guidance in Australia suggested that potential First Nations donors should be assessed more cautiously, on the basis that some had a higher risk of developing kidney disease themselves. Professor Kelly notes that newer research shows different outcomes — and internationally, First Nations donation is more broadly accepted. Australia is moving toward individual risk assessment for potential donors. This is a meaningful shift, but it is incomplete in practice.

Systemic racism. This is the harder category. Kelli Owen’s account — her family offering to donate, the system refusing — is not an isolated story. Professor Kelly’s research, and Owen’s direct experience, point to decisions being made about First Nations patients and families that are not being made on purely clinical grounds. That is a difficult conversation for a health system to have about itself. It needs to be had.

What this doesn’t resolve is the speed of change. Acknowledging the gap is not the same as closing it. Expanded rural visiting clinics require sustained funding and workforce. A cultural shift in transplantation assessment requires training and institutional accountability. Neither of those is quick.

2 cents: what this means for your terrain this week

If you are First Nations and have diabetes, high blood pressure, or a family history of kidney disease: ask your GP whether you have had your kidney function checked recently. A blood test measuring eGFR and a urine test measuring albumin-to-creatinine ratio are the starting points. Early detection changes what is possible. This is worth asking about directly, without waiting for your GP to raise it.

If you are a GP seeing First Nations patients with any of the above risk factors: kidney function screening at the next opportune visit is low-cost, high-yield, and frequently deferred. The RACGP 715 health assessment for Aboriginal and Torres Strait Islander patients includes kidney function — if your patient is eligible and hasn’t had one recently, that is a practical entry point.

The documentary In Contrast is screening in Sydney and Adelaide, with more screenings planned. For anyone wanting to understand what the transplant gap looks like from the inside, it is worth attending.

Verdict: yes — worth knowing about.

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Sources cited

1. New documentary spotlights ‘silent killer’ disproportionately affecting First Nations Australians — ABC News, 24 Oct 2026
2. Kidney Health Australia — chronic kidney disease information