Questions and Answers with The Transplant Team Consultant Transplant Surgeon Mr Gabriel Oniscu Mr Gabriel Oniscu is a Consultant Transplant Surgeon at the Royal Infirmary of Edinburgh, and is the Lead Clinician for the Live Donor Programme. He played a major role in transforming the donor operation from open surgery to keyhole surgery, and now Edinburgh is the only unit in the UK which offers laparoscopic single port surgery. Why did you choose transplant as a speciality? I always wanted to be a transplant surgeon. Transforming someone’s life with another person’s gift is a unique aspect of transplant surgery and being able to facilitate this is a great privilege. It is never just another day at the office for me. Describe your role Though I lead the live donation programme, and do the majority of donor operations, I have an active role in liver and pancreas transplantation. I also lead the clinical research looking at ways to improve transplant outcome using novel technologies for organ perfusion and reconditioning. What have been the most significant advances in transplantation in your view? There have been so many and is difficult to single out just one. Keyhole surgery for the donor operation and the paired exchange schemes have certainly revolutionised living donation. The development of novel perfusion technologies to recondition organs is the next “big thing” that will increase access to transplantation. What are the biggest challenges in your job? Being in 3 different places at once! Being a transplant surgeon on call can be very busy, and transplants don’t wait. What is the most rewarding part of your role? Without a doubt seeing a donor and recipient following surgery – it is an amazing gift. What advice would you give anyone considering donating a kidney? Donor safety is our main concern, and we would never want anyone to proceed if they were not sure. Talk about it, ask as many questions as you want, never feel pressurised to continue. Any queries – phone the Transplant Co-ordinators. Consultant Transplant Surgeon Ms Lorna Marson Ms Lorna Marson is a Consultant Transplant Surgeon leading the renal transplant programme in Edinburgh. She has a broad experience with recipient issues in live donor transplant amongst her other roles. Why did you choose transplant as a speciality? I had not planned to be a transplant surgeon, certainly it is not a sensible specialty for a mother of small children, as I was at the time. But I love the surgery, the ethical challenges around both living and deceased donation, as well as the exciting science. Above all, the amazing feeling of transplanting a patient and then going to see them afterwards, and they already feel better because of a functioning kidney. Describe your role I am a kidney and pancreas transplant surgeon, with a lead role in developing the renal transplant services in East of Scotland. I am the main surgeon for the recipients of living donors, and have worked as part of a team to develop our antibody incompatible transplant program. I also undertake research that is aimed to improve outcomes following kidney transplants, and I have national roles as Deputy Chair of the Kidney Advisory group, and Vice President of the British Transplantation Society. What have been the most significant advances in transplantation in your view? I think the development of the kidney sharing scheme, with incorporation of kidneys from non-directed donors has played a key role in the last 5 years in transplanting more complex patients. What are the biggest challenges in your job? Trying to balance everything that I do, so that I do it well, and taking time with my family. What is the most rewarding part of your role? The satisfaction of a patient recovering and feeling well with a functioning transplant. Sometimes patients write to me, and this is very satisfying What advice would you give anyone considering donating a kidney? It is difficult to give advice. I am always humbled when I speak to individuals who are considering giving a kidney, especially to someone they don’t know, and will never know. It is a big decision, so think about it carefully and talk to the people you are close to about it. Consultant Renal Physician Dr Lorna Henderson Dr Lorna Henderson is a Consultant Renal Physician at the Royal Infirmary of Edinburgh with her main focus being transplantation. She has been part of the team developing blood group and antibody incompatible live donor transplantation. Why did you choose transplant as a speciality? It was clear to me early on that I wanted to specialise in transplant nephrology. As a junior doctor, one of my first jobs was in the transplant unit in Edinburgh. I saw the difference transplantation could make to people’s lives and I really enjoyed being part of a multi-disciplinary team. I also have a background in immunology and this is very useful in transplantation. Describe your role I meet potential live kidney donors early in their journey to ensure they are medically fit to donate a kidney and I provide renal medical input to the multi-disciplinary decision making process. I also work with other colleagues to ensure the recipient is prepared for transplantation. I have a special interest in overcoming immunological barriers to transplant and I work with the team to decide the best approach for individual patients. What have been the most significant advances in transplantation in your view? I think the introduction of the paired exchange programme and altruistic donation have had a major impact on live donation. These two changes have resulted in a fantastic expansion in the number of live donor transplants. They have also helped many people who may have otherwise waited a very long time to receive a well matched kidney. Laparoscopic (keyhole) surgery for live kidney donors has also made a big difference to the speed of their recovery. There has been a number of new drugs introduced to prevent and treat rejection after transplant. These drugs and a better understanding of what happens to the immune system after transplant, have allowed previously very high risk transplants to be possible. What are the biggest challenges in your job? I think the biggest challenge is making sure the team is satisfied that it is safe and the right thing to do to proceed with a live donor transplant. Sometimes we have to decide that it is not the right thing to go ahead and this is always difficult for everyone involved and obviously disappointing for the potential donor and recipient What is the most rewarding part of your role? One of the things I find most rewarding is meeting the donor and recipient in High Dependency unit after both operations have been completed. What advice would you give anyone considering donating a kidney? I would encourage people who are thinking about live donation to get in touch with us. A live donor transplant can make a huge difference to a person’s life. I would also emphasis that no matter what the situation is, the donor’s health is always our top priority and there is never any obligation to proceed once we have been approached. Living Donor Transplant Co-ordinator Ms Kath Brown Kath Brown is one of the Living Donor Transplant Co-ordinators at the Royal Infirmary of Edinburgh. She previously worked in Glasgow in the same role, and shares her many years of experience. Why did you choose transplant as a speciality? It wasn’t so much of a choice as a natural progression from experiences in neurosciences and close links with transplant co-ordinators involved in organ donation. Describe your role My role involves providing information in a sensitive and caring manner at times of difficult family circumstances. My role also involves having a structured and organised approach to investigations, having the knowledge and experience to deliver difficult information. What have been the most significant advances in transplantation in your view? The changes in the law in 2006 allowed altruistic and paired exchange transplants which over the years have expanded to include long chains and opened up the possibility of doing 4 live donor operations in one day What are the biggest challenges in your job? Dealing with more complex scenarios such as liaising with 4 other transplant centres to organise operations on the same day in the kidney sharing scheme. Making the assessment process more efficient to take into account the needs of donors. What is the most rewarding part of your role? When it all comes together and working within the team! What advice would you give anyone considering donating a kidney? Listen to all the information and advice you are given. Think carefully and don’t underestimate the impact of live donor kidney transplantation. Consultant Transplant Psychiatrist Dr Stephen Potts Dr Stephen Potts is a Consultant Transplant Psychiatrist at the Royal Infirmary of Edinburgh. He has a wealth of experience in all aspects of live donation and transplantation, with a special interest in altruistic donation. Why did you choose transplant as a speciality? It chose me! My previous role in liaison psychiatry included one half day per week working with the renal unit and renal transplant team, as well as providing cover to my opposite number in the liver transplant unit. I soon found this the most interesting part of my role, and really enjoyed working among a multidisciplinary team of clinicians who brought a wide range of skills, a can-do attitude, and a share common purpose. Describe your role Transplant psychiatrist. Colleagues elsewhere in the UK do similar work, as part of other jobs, but this is the first post set up exclusively in this way. I see recipients and donors, where appropriate, before and after transplant, referral from transplant co-ordinators, physicians or surgeons. Sometimes this is because of previous problems with anxiety, depression or similar conditions, sometimes because the referrers identify a need in their own assessments, and sometimes because donors and recipients themselves request it. What have been the most significant advances in transplantation in your view? The development most evident to me is the introduction of altruistic kidney donation. In a decade this has gone from something illegal in Britain to an increasingly common, and widely accepted element of the transplant service, which can make a big impact, especially when it starts a chain of donor-recipient pairs. What are the biggest challenges in your job? Dealing with the transplant co-ordinators………. What is the most rewarding part of your role? Seeing someone with kidney failure, who is close to needing dialysis, getting a pre-emptive transplant from an altruistic donor; being in the operating theatre when the kidney is plumbed in, to witness the everyday miracle of it producing urine within moments of the artery clamps being released; and then seeing donor and recipient leave hospital on schedule, without complications. What advice would you give anyone considering donating a kidney? Read up about it: there’s plenty of information out there. Talk about it, to your family, your GP, and the transplant team. And finally, rest assured that the team will not consider going ahead unless they are confident that the risks are as low as they can make them. Independent Assessor Anne Mulligan DCS Anne Mulligan, Deacon of the Church of Scotland, is one of the team of Independent Assessors who act of behalf of the Human Tissue Authority. For many years Anne was a Hospital Chaplain at the Royal Infirmary of Edinburgh providing great support to the Transplant Unit. Here she talks about her role as Independent Assessor. Why did you choose transplant as a speciality? When I was a Hospital Chaplain I was always interested in the ethics of organ donation and transplantation, and was fortunate to see the difference the gift of a transplanted organ can make to people’s lives. Describe your role I act on behalf of the Human Tissue Authority. I ensure that all is order and the donor has the capability to understand all involved, the transplant team have fully prepared the donor and recipient and they understand the risks involved. I confirm identity and the relationship of the donor and recipient (where applicable). I also establish that no coercion or reward is involved. What have been the most significant advances in transplantation in your view? Seeing the development of live donor transplants expand from just family members to spouses and friends and now altruistic. What are the biggest challenges in your job? Making sure I cover all areas – it is such a privilege to hear the stories of donors and recipients, I sometimes need to make sure that I have covered all the areas necessary for the application formalities. What is the most rewarding part of your role? Meeting the people, and contributing in a small way to the marvelous work that happens in the transplant unit. What advice would you give anyone considering donating a kidney? Be sure to take on board the emotional aspects of kidney donation and the impact on your relationship with the recipient. Transplant Charge Nurse Lynne Beveridge Senior Charge Nurse Lynne Beveridge leads the nursing team in the Transplant Unit, caring for patients undergoing liver, pancreas or kidney transplant and live donors. Why did you choose transplant as a speciality? I was given the opportunity to transfer when I gained promotion to the Transplant High Dependency Unit and then the opportunity arose for me to manage the Transplant Ward – Transplant nursing is a challenging, motivational area of nursing and I thrive with the opportunity to work with both recipients and live donors of transplant organs. Describe your role Senior Charge Nurse in ward 206 Transplant – managing and improving patient and staff experience at all times. Leading an exceptional group of dedicated staff to enable a high standard of patient care What have been the most significant advances in transplantation in your view? The clinical operation and the techniques that have developed to allow shorter recovery time. The ongoing motivation to expand the knowledge around Organ Donation and Transplantation. What are the biggest challenges in your job? At times the number of beds I have available within the clinical area and assuring that the most appropriate patients are allocated to the correct bed spaces; reducing risk to patients at all times. What is the most rewarding part of your role? To watch and observe the difference in quality of life that a transplant can make to a persons life. To observe patients embracing the gift they have received and thinking positively about their future following transplantation. What advice would you give anyone considering donating a kidney? This is a precious gift that anyone could offer to another person and I respect all live donors. Thank you.
