In 2020/2021, 4,440 New Zealanders used some form of dialysis. If recent trends continue, the number of people using dialysis will increase to around 5,700 by 2031/32 – an increase of over 30 percent in ten years. Dialysis is a costly intervention at approximately $115,712 per year. The equity impact of dialysis as the default treatment for end-stage kidney disease (ESKD) is particularly concerning: Māori and Pacific New Zealanders represent over 60 percent of dialysis users.
Dialysis offers a low quality of life and an average life expectancy of only six years compared with 15 years and 20 years for deceased and live donor transplantation, respectively. Health system costs over 20 years indicate potential savings of up to half a million dollars per person, with transplants paying for themselves within three years. Renal transplants represent a rare opportunity to transform lives while saving money.
New Zealand ranks 16th in the world for its rate of renal transplantation. Countries with similar health systems have succeeded in significantly lifting their transplantation rates, but the funding flexibility and coordination required have prevented similar progress here. However, the health and disability system reforms present an opportunity to redesign renal services, funding, and leadership, with a focus on lifting the rate of renal transplantation.