More facilities are needed if the lung transplant programme is to advance. David Labanyi reports
Surgeon Freddie Wood admits to a quiet sense of achievement following the successful completion of the State's first double lung transplant at the Mater Hospital in Dublin three weeks ago.
"The pressure to start to deliver the programme from the media, the Department [ of Health] and colleagues was huge, and now, yes, now we have all started to relax a bit," he says.
On January 13th a team led by Wood carried out the double transplant on a man in his 50s from the west of Ireland suffering from emphysema.
The man was recently discharged from the Mater and is now very well, according to Wood.
Technically, a double transplant is no more complex than a single organ transplant, Wood explains, the only difference being the size of the team required. And this team has to be swiftly assembled once donor organs become available.
"We got the call offering the donor organs at 3pm on a Thursday afternoon and the patient was returned to intensive care the following morning at 6.30 after five hours of surgery."
During that time 21 people, including six consultants led by Wood, worked on the procedure.
"The team you need is quite vast. There are huge organisational issues."
A second team was needed to remove the organs from the donor.
"A huge amount of vocational and professional goodwill allows this to happen. For example, the theatre nurses have put up a volunteer list of those willing to be called in when organs become available."
Since Veronica Doyle from Limerick became the first person to undergo a lung transplant in Ireland last May, there have been six lung transplants, two of which were doubles, the second of which took place just under two weeks ago.
When the lung programme reaches its capacity, Wood expects to do about 15 transplants per year. "It could even be more because we have the recipients.
"As I speak, there are 18 patients on the Mater lung transplant list and a further 19 on the Newcastle list."
Many of those on the waiting list are cystic fibrosis sufferers who require double lung transplants. The average life expectancy for a cystic without a transplant is around 32-33 years of age, Wood says.
Previously all Irish patients requiring a lung transplant had to be referred to the Freeman Hospital in Newcastle.
A number of patients will remain on that list until the unit in the Mater is expanded.
"To do 10 or more lung transplants a year and to repatriate the patients on the Newcastle list on to the Mater list, we need Phase 3 of the transplant proposal to be established."
This requires the building of an additional operating theatre, a seven-bed transplant ward and an isolation facility for the transplant patient after discharge from the high dependency unit.
"We had expected phase 3 would have been financed by this stage. It will have to be discussed by the HSE and the Department of Health and we are due to meet them soon."
Wood says 85 per cent of the personnel required for the lung transplant programme are now in place.
The programme was established by the then minister for health, Brian Cowen, in 1998 and there were questions last year about why it had taken so long for the first transplants to be carried out.
"To get the whole lot together doesn't just happen overnight," says Wood.
"We had to form a very well- developed multidisciplinary team that involves all the consultant components - surgery, chest medicine, transplant medicine, anaesthesia, intensive care microbiology, psychiatry, then the paramedical staff and social worker. Then you have nursing and countless others.
"And at the moment, every lung transplant patient from here or Newcastle is being looked after at the Mater, every single one of them. There are 58 on transplant physician Jim Egan's list. These patients all require follow-up treatment when complications arise."
The unit is also working with heart transplant patients.
Wood is uncomfortable with the focus on the medical team, believing the families of donors are much more worthy of praise.
"Everyone talks about the surgical team but a transplant couldn't happen unless the family of someone immediately deceased is so committed to helping someone that they offer their relative's organs for donation."
He says Ireland has an excellent organ donor rate of roughly 22 per million of population, the fourth highest in the EU and twice the rate of the UK.
However, he notes this rate could be higher.
"Dr O'Dwyer in Beaumont did a review of organ donation two to three years ago and found that about 25 per cent of the relatives of potential donors withdrew their consent."
Wood says because there is no legislation covering this area, the consent or wishes of a person dead from irreversible brain damage is subservient to the wishes of their next of kin.
"The express consent of the patient isn't relevant at all because there is no law covering it. A donor card is just a personal indication. Their family has the final say."
Wood admits discussing donation is exceptionally demanding for the family and the medical professional.
"If I was looking after you one minute, trying to keep you alive and the next minute you are dead, it is hard to ask your relatives 'would they consider organ donation'.
"No matter how much training you have, it is exceptionally demanding each time you have to do it."
Wood says many medical transplantation staff believe a system of donor nurse co-ordinators, similar to that operating in Spain, would help.
"These nurses would be trained in bereavement counselling and come specifically to spend time with the family and to then request consent.
"They are separate to the care of the patient," he says.
"But no transplant operation can happen without someone dying and donating their organs. It is that simple."
Everyone talks about the surgical team but a transplant couldn't happen unless the family of someone immediately deceased is so committed to helping someone that they offer their relative's organs for donation