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Life as a renal transplant surgeon

Last night’s episode of BBC Two’s Hospital showcased the amazing skill of our renal transplant team, who carried out three transplants in one day – with kidneys donated from both living and deceased donors.

“As a renal transplant unit we cover 3.5 million people. We carry out around 130 kidney transplants per year, which is twice the number of transplants compared to when the unit first opened on the Royal site 20 years ago. As of last weekend, we had carried out 106 transplants since April 2018, which is already ahead of the previous year. But it’s not all about numbers; it’s about looking after the patients well. Everyone here has a real vested interest in our patients. It’s a team effort.” 

For consultant transplant surgeon Dan Ridgway, his patients are his number one priority. Despite the rising numbers of patients at the Sir Peter Medawar Renal Transplant Unit at the Royal, the balance the team keep between the numbers of kidney transplants they carry out and excellent patient care is unerring.

"Looking at the number of patients, waiting list times and types of kidney transplant we do – we’ve pretty much got it right. We have a small waiting list due to regular turn over – if you get a kidney transplant here in Liverpool you generally get it in half the average national waiting time. On average it’s 3 years, here it’s 18 months,"

said Dan, who joined the unit in 2012. Hailing from Yorkshire, he trained in Leicester before going to Leeds and working in various trusts around the North.

“I always wanted to become a transplant surgeon as it has a good mix of challenging surgery and medicine. The really nice part is looking after a particular patient and their family for so long. You see them for years, so you get to know them really well throughout the transplant process and carry out different operations on the same small group of patients. After transplant it’s almost an instant but not permanent fix, especially compared to dialysis, so it’s rewarding in that respect. I like doing transplants that will last.”

Liverpool is one of 24 kidney transplant centres in the UK. On average the unit carries out a third of transplants from living donors and two thirds from deceased donors. From a deceased donor, 95% of kidneys will last 1 year, with 89% lasting 5 years. A kidney from a living donor has a 97% chance of lasting a year, and 89% for 5 years. Mortality rates are generally lower in the long term if a patient has received a kidney from a living donor and typically, a kidney from a living donor will function more quickly and last longer than deceased.

"Liverpool should be extremely proud of the transplant unit, it is special. We have a great team here, the nurses on 9A are unbelievable – the best ward staff I’ve ever worked with."

"It’s unusual to have a ward that is specifically just a transplant ward and I’ve never not be able to do a transplant because there wasn’t a bed available for the patient to recover afterwards. I’m really proud of the team, they all need a massive amount of credit as sometimes it can be a huge ask carrying out three or four transplants in one day.”

Becoming a transplant surgeon is a role which is becoming increasingly difficult to fill. The long working hours and emergency work mean that the work/life balance can be challenging – but working in a team as supportive as the one here at the Royal makes a huge difference. Some of the renal transplant team with Defenders4Kidneys

From the specialist nurses, transplant co-ordinators, healthcare assistants, pharmacists, dieticians, social workers and administration staff who solely work with transplant patients, to the nephrologists, immunologists, anaesthetists and theatres staff liaising with the surgeons, the team work side-by-side to provide unmatched expertise before and after a transplant.

“I don’t see my family as much as I would want, but it’s a rewarding job. Nowadays trainees know they can go into so many other specialities that may be seen as easier and involve more predictable 9am-5pm work; but no day is the same here.”

There has been a shift in transplant practice over the past decade, with a move toward encouraging more people to come forward as living donors. GPs are making earlier referrals of patients with kidney failure, so the team are now trying to mention transplant as a treatment option as early as possible.

"We want to make that happen earlier – for a patient to get a transplant first rather than dialysis."

"We would encourage patients and their families to discuss the option of having a live donor transplant as that really does represent their best option of getting a good quality long term treatment for their kidney disease. That trend is likely to continue going forward and it would be nice to offer transplantation to as many patients as possible.

“It’s important that both recipients and donors receive the best care after their surgery; you can never quite discharge a renal transplant patient or their donor. Patients should be reassured that, having received or donated a kidney, you will be looked after by us for life.”

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What service do the renal transplant team provide?

The Renal Transplant Unit, also known as the Sir Peter Medawar Transplant Unit, offer a high quality kidney transplant service for patients in Merseyside, Cheshire, North Wales and further afield.

The unit performs living and deceased donor kidney transplants on approximately 130 patients each year. The unit boasts a first-rate reputation for its innovative clinical research, academic excellence, and excellent success rates. The programme's interdisciplinary approach to kidney transplantation integrates surgical, medical and clinical support specialists to engage in the continuous care and management of the patient through every stage of a successful kidney transplant.

Organ donation

There are currently around 6,000 people on the UK transplant waiting list. Last year over 400 people died while waiting for a transplant. In Liverpool, approximately 146,217 people are registered as organ donors. This represents 30% of the population of the city.

Deceased donation

Around 24 million people are on the NHS Organ Donor Register. In the financial year 2017/18, more than 1,500 people in the UK donated their organs after they died. It is the highest ever number of donors in the UK - meaning that more people than ever have had a transplant to transform their life.

Discussing your consent with your family is a really important conversation to have now so that they can support your decision to donate, if and when the time comes. Click here to sign up to the register www.organdonation.nhs.uk

Living donation

Across the UK, more than 1,000 people each year donate a kidney or part of their liver while they are still alive to a relative, friend or someone they do not know.

The most commonly donated organ by a living person is a kidney. A healthy person can lead a normal life with only one functioning kidney. The average waiting time for a kidney transplant from someone who has died is more than two and a half years. For some ethnic groups and people for whom it is difficult to find a compatible donor, the wait is even longer and sadly, some people die waiting.

There are numerous ways you can become a living donor:

  • Donating to a family member or friend: donating a kidney a close relative, partner or friend is called directed altruistic donation.
  • Donating to someone you don't know: donating a kidney to someone you have no previous existing relationship is called non-directed altruistic donation. You can register your interest in altruistic donation.
  • Paired or pooled donation: If you are not a suitable 'match' for someone you wish to donate to, it may be possible for you to join a sharing scheme and be matched with another donor recipient pair in the same situation and for the donor kidneys to be 'exchanged' or 'swapped'. More information on this can be found here.
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