About the NIKTT
Background
The National Indigenous Kidney Transplantation Taskforce (NIKTT) was established to improve access to, and outcomes of, kidney transplantation for Aboriginal and Torres Strait Islander people. While First Nations peoples in Australia experience end-stage kidney disease at significantly higher rates than non-Indigenous Australians, systemic inequities continue to result in lower rates of waitlisting and therefore transplantation (1). The need to develop a Taskforce and build a network of coordinated patients and clinicians came from the 2018 Transplantation Society of Australia and New Zealand (TSANZ) performance report (2) that outlined clear recommendations to improve kidney transplantation access and outcomes for Aboriginal and Torres Strait Islander people. The report listed 35 recommendations to improves access, mapped against state, territory, and Commonwealth Government responsibilities as well as actions to be taken up by a national taskforce.
Established in 2019, the NIKTT was created in direct response to Recommendation 1 of the TSANZ report. The Taskforce was established with 35 members, comprising a diverse group of Aboriginal and Torres Strait Islander people, non-Indigenous allies, patients, clinicians, and organisational stakeholders. The Taskforce was charged with progressing three key recommendations from the TSANZ report:
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Enhancing data collection around transplant waitlisting,
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Investigating cultural bias in kidney care settings, and
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Piloting models of care to improve access to the transplant waitlist.
Over a three-year period, the NIKTT implemented a broad program of work. This included the establishment of Indigenous Reference Groups at transplant units across the country, the commissioning of a national report on cultural bias in kidney care, and the piloting of eight distinct projects designed to test new approaches to improving equity in access to transplantation. In addition, data collection systems at renal units were expanded to better understand the barriers preventing Aboriginal and Torres Strait Islander people from being waitlisted. The initial phase of funding and activities concluded in 2023, laying the foundation for continued national efforts in this area.
The results of this initial work were published in a number of formats, including:
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A Final Report submitted to Government,
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A series of papers in a supplement of the Medical Journal of Australia, and
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Through a Position Statement endorsed by members of the NIKTT community that was presented back to all State, Territory, and Federal Ministers for Health and Indigenous Affairs.
Initial Recommendations
Overall, the findings from the first phase of NIKTT work resulted in three groups of recommendations.
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Immediate improvements to access and services through sustainable funding of outreach assessment clinics, Indigenous Reference Groups, and an increased Aboriginal and Torres Strait Islander renal health workforce.
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Ongoing Secretariat to monitor and progress transplantation equity. Coordinated efforts are essential to identify issues, catalyse activity, maintain profile and focus on transplantation. A national Secretariat would provide leadership, collaboration, monitoring, and reporting, and should be resourced for a minimum of three years to continue national coordination of transplantation equity work.
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Investigate additional measures to address drivers of inequity, including initiatives that target current barriers to waitlist access as well as initiatives that target barriers in other parts of the transplant pathway. Research into, and implementation of, initiatives that address additional drivers of inequity should be nationally resourced and coordinated to understand best practices.
These recommendations, alongside other findings gathered throughout NIKTT work, were provided to the Commonwealth Government in a number of forms, including as direct input during the consultation phase for the National Strategy for Organ Donation, Retrieval, and Transplantation.
Ongoing Work
Recognising the strength of a dedicated network and Secretariat focused on transplantation equity, the Commonwealth Government provided In January 2024, the Commonwealth, represented by the Department of Health and Aged Care committed funding for the National Indigenous Kidney Transplantation Taskforce (NIKTT) through the Bridging Extension of the National Indigenous Kidney Transplantation Taskforce to Maintain Progress Towards Transplantation Equity Agreement (NIKTT Bridging), Activity ID: 4-J1UOL4U. NIKTT along with the support of the Transplantation Society of Australia and New Zealand (TSANZ) continued its mission to improve access to kidney transplantation for Aboriginal and Torres Strait Islander peoples, ensuring culturally safe, equitable, and effective pathways to care.