Despite extra funding this year, a living transplant programme is still some time away. Theresa Judge reports
The Irish Kidney Association has criticised the Government for allocating what it calls "inadquate" funding to establish a living transplant programme.
Chief executive Mark Murphy says that up to 50 extra transplant operations a year could be carried out if such a programme was set up. Last year there were 129 kidney transplants performed but just two of these were from living donors.
In the Budget Estimates last November, the Government announced an additional €8 million to improve renal services generally and to start a living transplant programme.
It was not specified how much of this €8 million would be set aside for the transplant programme and Murphy says he is concerned that with the number of patients requiring dialysis increasing by some 16 per cent each year, this could take up practically all of the allocated money. A major factor causing the increase in dialysis is the growing incidence of diabetes.
"There is an extra 150 people on dialysis now than there was a year ago and that alone could cost an extra €10 million."
Murphy says he is basing his calculations on the fact that the State pays €68,000 per patient per year to a private provider of dialysis, as there are no statistics on the cost of providing dialysis in the State system.
Dr Liam Plant, a renal physician and chairman of the National Renal Strategy Review Group established by the Government, says however the fact that a transplant programme has been identified as a specific element for central funding represents "a major change".
He says the review group will finish its report this summer and one of its "core priorities" will be to increase the number of people getting transplants generally. "Living transplantation will be one of its core recommendations," he says.
Plant believes some delay in establishing a living transplant programme has to be expected, but he is satisfied with the progress being made although "everybody would like it to be quicker".
He says business plans have been drawn up. "I would be tremendously disappointed if there is not significant progress over the next 12 months. It also has to be remembered that this €8 million is multi-annual funding, it is not a once-off this year."
Plant says that setting up the programme will require additional nursing, surgical and medical staff and more transplant co-ordination staff. It will also require "reliable access to theatre space".
Mark Murphy says that one of the problems with the current system is that there is no dedicated theatre in Beaumont Hospital in Dublin, where all kidney transplants are performed, for transplant operations.
"At the moment they have to beg, borrow and bump lists [for theatre space], and ideally for living transplants, you should have two theatres side by side," he says.
The main aim of Organ Donor Awareness Week, which runs from April 1st-8th, is to encourage people to carry an organ donor card and to discuss their wishes with their family. The awareness week campaign is run by the Irish Kidney Association, which also promotes and distributes the donor card. Funds will be raised through the sale of Forget me Not flowers and donor keyrings to help people on dialysis and those who have had transplants.
Both Mark Murphy and Dr Plant stress the huge benefits of organ donation to people awaiting transplants. Murphy says that donating an organ to a person on dialysis allows them to go from "living a half life to getting a 95 per cent normal life".
It also increases life expectancy very considerably. Kidney patients require dialysis three times a week for periods of up to five hours and they may also have to travel considerable distances to a dialysis centre. In addition to the quality of life issue, transplantation is also very cost effective, he says.
Plant says he would like to stress to people that by carrying an organ donor card they could make "a huge impact on the life of another person" as a transplant can "transform" a person's life. He says the card helps both the donor's family and professionals at the time of a decision about donating organs.
Murphy says he is concerned at the "imbalance" in donation rates across different intensive care units. "It appears that some intensive care units are less active than others in seeking out donors," he says.
The Irish Kidney Association wants Ireland to follow Spain's example and appoint a dedicated professional to all intensive care units to actively seek donors. Spain has the highest rates of organ donation in the European Union with a rate of up to 35 per million of the population.
In the Republic, the rate of organ donation is currently at 18 per million of population but has been as high as 22 per million of population. This is significantly higher than in the UK where the rate is 13 per million of population.
Plant says the different rates of donation in different hospitals may reflect the kind of patients being treated. For example, the highest donation rates are at the State's two hospitals with specialist neurosurgical units. He says that while the Spanish system has been very effective, there are different systems in place in different EU states and "the debate rages as to which is better".
For this reason, a living transplant programme is very important because it is guaranteed to increase donation rates, he says, while any system designed to increase rates from deceased people can only be "speculative".
While an organ donation card is not legally binding and the decision ultimately rests with a donor's next of kin, Mark Murphy says in practice a family very rarely goes against a person's wishes.
To encourage people to discuss the issue with their family, the Irish organ donor card asks for the card to be countersigned by the next of kin.
Organ donor cards can be obtained by phoning the Irish Kidney Association at Locall 1890 KIDNEY (1890 543639).
Why donations are needed:
500 people are awaiting transplant operations.
About 400 of these need kidney transplants.
Unlike many other EU countries, there is currently no living transplant programme - in 2005 there were just two living kidney transplants.
129 kidney transplants took place in 2005 (147 in 2004).
57 liver transplants were peformed in 2005 (45 in 2004).
11 heart transplants took place in 2005 (seven in 2004).
Five pancreas transplants were carried out in 2005 (in conjunction with kidney transplants).
Eight lung transplants were performed in 2005 (for the first time three were performed in Ireland, the remaining five in the UK)
There are 1,364 people on kidney dialysis.
Donor numbers: 76 in 2005; 89 in 2004; 86 in 2003.
Organ Donor Awareness Week takes place from April 1st-8th.