Australia, like many countries around the world, has experienced a decline in living donor transplantation compared to deceased donors. The 2020 Australia and New Zealand Dialysis and Transplant Registry Annual Report (1) (reflecting complete data to 2019) reports that a total of 1104 kidney transplants were performed in 2019, an overall rate of 11.6 transplants per 100 dialysis-years (of people on dialysis aged 15−64 years). Living donor kidneys accounted for 22% of all kidney transplants performed in Australia in 2019. Of the 12,815 (prevalent) people with functioning kidney transplants, 30% (3797) originated from living kidney donors, and living kidney donors were more likely to be female (57.2%) (2010−2019).
The overall proportion of living donor procedures compared to deceased donor transplants fell from 29% in 2014 to 21% in 2018 (2). However, this was predominantly due to the steady overall increase in deceased organ donors, as the actual number of living donor kidney transplants remained relatively steady over that time (range 238−271), with a peak of 354 living donor transplants performed in 2008. The Organ and Tissue Authority, an independent agency within the Australian Government health portfolio, was formed in 2009; since then, deceased donors have more than doubled. In 2008, there were 259 deceased organ donors, and in 2019, there were 548. Donation after circulatory death (DCD) has increased over that time and currently accounts for approximately one-third of deceased donors in Australia.
While the overall proportion of living versus deceased kidney donors is now 22%, the proportion of living donors for recipients aged less than 25 years is generally greater than 40%. Additionally, 46% of all first kidney transplants in 2019 from living donors were performed preemptively (1). Preemptive transplantation is not available to people waitlisted for deceased donor kidneys in Australia.
The Australian and New Zealand Kidney Paired Kidney Exchange (ANZKX) program has been responsible for a significant proportion of the living donor kidney transplants (Figure 1). The program has evolved with strong clinical oversight to maximize its impact on, for example, continuous matching, inclusion of ABO incompatible matching, hepatitis B core antibody positive donors, and human leukocyte antigen (HLA) compatible pairs. Started in Australia in 2010 and extended to include New Zealand in 2019, ANZKX has facilitated over 400 kidney transplants since inception and now results in approximately 50 kidney transplants each year (3).
Australia and New Zealand Dialysis and Transplant Registry. ANZDATA 43rd Annual Report 2020 (Data to 2019). Chapter 8: Kidney Donation. 2020. https://www.anzdata.org.au/wp-content/uploads/2020/09/c08_donation_2019_ar_2020_v1.0_20201222.pdf
Australia and New Zealand Organ Donation Registry. ANZOD Annual Report 2021. Section 5: Deceased Donor Kidney Donation. 2021. https://www.anzdata.org.au/wp-content/uploads/2021/08/s05_kidney_2021_v0.5_20210802.pdf