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

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.