With demand for organs increasing unrelentingly, the option of "live donation" is being encouraged. Padraig O'Morain reports
Since 1990, the number of people on renal dialysis has more than doubled but the yearly number of kidney transplants has scarcely changed, according to Mark Murphy, chief executive officer of the Irish Kidney Association.
Part of the answer, he believes, is for more hospitals to encourage relatives to consider organ donations when a loved one dies. He would also like to see the encouragement of donations by non-relatives who have emotional links to the person receiving the kidney, mainly spouses and partners.
Currently, almost all kidney transplants are from people who have died and transplants from living donors are rare - only 10 since 1990.
More than 1,000 people are now on dialysis for kidney failure and, of these, about 250 to 275 would benefit from a kidney transplant, according to Dr Peter Conlon, consultant nephrologist (kidney specialist) at Beaumont Hospital.
The remainder are generally older patients with multiple illnesses and these would make a transplant medically inadvisable. "Up to two years ago we had 130 people on the list and we could do 130 transplants," he says.
"Now there are more nephrologists around the country and more people on dialysis living longer."
As a result, the waiting list is now about two years. Like Mark Murphy, he believes kidney donations from living relatives should be encouraged.
"In the US, more than half of transplanted kidneys are from living donors, related and non-related."
A conference in the Royal College of Surgeons in Ireland next Friday will tease out aspects of donation by living donors and one result of it, he hopes, will be to raise awareness of the possibilities of this approach.
The fact remains, however, that most dialysis patients are not medically suitable for transplant and face two or three visits a week to hospital for two or three hours' dialysis at a time.
But there are too few dialysis units to meet demand, according to Dr Conlon and Mr Murphy.
"Every dialysis unit in this city is at bursting point," says Dr Conlon. "If a new patient needs dialysis, we wonder where on earth will we find a space for them."
Mr Murphy says, and Dr Conlon agrees, many patients are receiving two rather than the recommended standard three dialysis sessions per week.
He complains that a woman in Longford is being sent on a 186-mile round trip to Sligo three times a week for dialysis because Cavan General Hospital does not have the capacity to treat her.
The North Eastern Health Board told The Irish Times: "We have nine bays at Cavan General and 45 people on dialysis. This is the maximum number we can have within our current budget. We have seven patients on a waiting list."
The NEHB also sends some patients to Daisyhill Hospital in Newry for dialysis. Demand on facilities means some patients are attending for dialysis at three, four and five o'clock in the morning, Dr Conlon says. Each session can last for three to four hours.
But he believes "in the next three years, dialysis is going to be completely transformed" in Dublin. There will be a new 44-station unit at Beaumont, a new 33-station facility at the private Beacon Clinic in Sandyford and more stations at St Vincent's University Hospital.
This will mean more people can have dialysis and they can have it during daylight hours and not at three in the morning, he says.
Mr Murphy, however, is critical of what he says are advanced plans by the ERHA to send public patients for dialysis to the Beacon Clinic. It would be preferable to develop the public dialysis services at Beaumont, Tallaght, the Mater and St Vincent's, he says.
The ERHA says it needs to find extra, short-term capacity until the new unit is ready at Beaumont Hospital. It also says discussions on proposals put forward by the Beacon Clinic "are still at the preliminary stage".