BOOK 4

2nd Edition

IKA RENAL SUPPORT CENTREBeaumont Hospital

Beaumont, Dublin, D09 Y5R3Ph: 01-8093000

Email: renalcentre@ika.ie

IRISH KIDNEY ASSOCIATION CLG

The Irish Kidney Association CLG, Company Limited by Guarantee, is a national voluntary organisation of

patients, family carers and supporters which offers support for all patients with end stage kidney disease.

Through its 25 local branches, patients can meet other kidney patients and share experiences, problems

and, most importantly, solutions.

On a national and local level the IKA organises ‘World Kidney Day’

activities, around the third Thursday in March, to raise awareness

of kidney disease in Ireland. The Association is also known for its

national organ donor awareness campaigns the biggest of which

takes place in the first week of April each year.

The IKA provides holidays every year, for kidney patients who are either receiving dialysis treatment

or are transplanted. It also has a Support Centre, in the grounds of Beaumont Hospital, which offers

on-campus accommodation for kidney patients and their families attending any Dublin hospital and short-

term accommodation for the families of seriously ill patients from outside the Dublin area.

IRISH KIDNEY ASSOCIATION CLG, Donor House, Block 43A, Parkwest, Dublin, D12 P5V6Phone: 01-6205306. Lo-Call: 1890-543639 (1890-KIDNEY)

Email: info@ika.ie. Web: www.ika.ieCHARITY REGISTRATION NUMBER: 20011260

www.facebook.com/IrishKidneyAssociation www.twitter.com/IrishKidneyA

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PREFACE

For people with kidney disease, the treatmentoptions are dialysis and, in suitable patients,transplantation. Kidneys for transplantation come

either from people who have donated their organs afterdeath or from a living donor. A living donor is usually arelative, spouse, or close friend.

This is the second edition of BOOK 4, which addressesthe area of the ‘living donor’ programme. It has beenwritten so that people who are considering livingdonation can have the opportunity to read about the risks, benefits, investigations, procedures andfollow-up associated with donating a kidney. Everything covered in the book will be discussed with you,in person, with the medical staff. The book is in no way a replacement for face-to-face communicationsbetween the transplant team, the potential donor, the recipient and their families.

THE INFORMATION IN THIS BOOK WAS ORIGINALLY COMPILED AND WRITTEN BY:Phyllis Cunningham, RN; Dr. Ailín O’Dea, Psychologist;

Ms. Dilly Little, FRCSI and Prof. Peter Conlon, FRCPIRe-edited by Ruth O’Malley, Prof. Peter Conlon and Olive McEnroe

If you wish to learn more about chronic kidney disease, dialysis or transplant treatment options, you canconsult the other books in this series addressing these topics. BOOK 1 deals with the functions ofthe kidney, types of kidney disease, diagnostic tests and medicines usedto treat kidney conditions. BOOK 2 deals with haemodialysis and peritonealdisalysis. BOOK 3 covers kidney transplantation in more depth whilstBOOK 5 is aimed at helping patients with kidney disease learn more abouttheir illness and is specifically written for people who have been informed thatthey have impaired (or reduced) kidney function and are classified as havingChronic Kidney Disease (CKD). BOOK 6 aims to help patients and familiesmaintain their emotional health in the face of what can be a serious illness.

More information is available from the transplant team at BeaumontHospital, Ph: (01) 8093119 or from: www.beaumontkidneycentre.ieWe do hope you find it helpful.

FEBRUARY 2016

CHAPTER 1Living Donation3CHAPTER 2Why Become a Living Donor?7CHAPTER 3Risks and Benefits10CHAPTER 4Living Donor Evaluation Stages13CHAPTER 5Who Makes the Final Decision16CHAPTER 6The Science in More Detail20CHAPTER 7Emotional Aspects23CHAPTER 8The Operation25CHAPTER 9Resuming Normal Activities27CHAPTER 10General Information28

CONTENTS

APPENDIXContributorsIKA Renal Support CentreContact NumbersOther Sources of Useful Information

32

LIVING ORGAN DONORREIMBURSEMENT SCHEME30

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©These books have been produced by the renal teams at BeaumontHospital and, save where otherwise specified, the content of all pagesare copyright to them. No matter may be reproduced or stored in anyway without the written consent of the Editors.The books have been printed and distributed by the Irish KidneyAssociation. Further copies are available from IKA, Donor House,Parkwest, Dublin 12. Ph: 01-6205306.

The information contained within this book is correct at time ofgoing to press. This book essentially pertains to the practices atBeaumont Hospital. Other Kidney Units may use differentpractices. This book should be used as a guide and referencetool only.

Asuccessful kidney transplant is often thebest treatment for people with end stagekidney disease (ESKD). A kidney transplant

provides the best opportunity for good long-termhealth. It also offers better long-term outcomesthan dialysis, which is the other major treatmentoption for people with kidney disease.

In Ireland, the majority of transplanted kidneyscome from people who have been declared brain-stem dead. This occurs in hospital intensive careunits and is often the result of an individual’ssudden death. When a person’s organs are offeredfor donation, after their death, that person isknown as a ‘deceased donor’. Research suggeststhat living kidney donation might offer a number ofadvantages to the recipient when compared to adeceased donor transplant (see list below).

SOME OF THE ADVANTAGES OF LIVING DONATION ARE AS FOLLOWS:

l The transplant can be planned in advance.

l The transplant can occur earlier, so the recipient may spend less time on dialysis or evenavoid dialysis altogether.

l The donated kidney spends less timein storage.

l Donor-recipient tissue matching canbe better, which might mean a lowerchance of the kidney being rejected bythe recipient’s body.

l Long-term results are better for therecipient, when compared with adeceased donor kidney.

CHAPTER 1

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LIVING DONATIONSince the make-up of the families can be similar,

or more rarely – as in the case of identical twins –identical, the chances of the recipient’s bodyrejecting the donated kidney is less with a donorkidney from a family member. Some of theseadvantages of living kidney donation are also true

for donors who are notgenetically related to the

recipient, such ashusbands or wives. Itis, therefore, worthexploring thepossibility of a non-

related living donor ifthis is an option for a

person in need of a kidneytransplant.

“A kidney

transplant provides

the best opportunity

for good long-term

health.”

Someone who is thinkingabout donating one of theirkidneys to help a loved onehas many things toconsider. The medical staffwill need to do a complexseries of tests, which maytake quite a long period oftime. This is to make surethat the donor is in goodphysical and mental healthand that their kidney issuitable for transplantation.

Studies have concluded if donors are carefullyselected and screened the risk of experiencingserious problems (such as kidney disease later inlife) from donating a kidney is very low. There issometimes a slight rise in blood pressure orincreased loss of protein in the urine for the donor,but this does not usually impact on the donor’shealth in the long-term.

The renal unit, at Beaumont Hospital, plans tofollow-up all living donors, on an annual basis, forlife so that any health issues can be detected at anearly stage. These issues will be discussed in moredetail throughout this book.

WHAT DOES A POTENTIAL LIVING DONOR NEED TO CONSIDER?

It is worth remembering, however, that theoperation to remove a healthy person’s kidneycarries the same risk as any major surgicalprocedure. Although all possible precautions aretaken, there are always risks when undergoingsurgery.

There are also practical issues that need to beconsidered, such as the time taken off from workfor the investigations and after the operation. It isalso important to consider domestic responsibilitiesand practical arrangements, such as looking afterchildren.

In addition, a number of investigations areperformed that may uncover a previously unknownmedical condition

THE RISKS AND BENEFITS

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One of the most frequent concerns of potential living kidneydonors is whether the loss of one kidney will adversely effectthem in later life.

A healthy person can live a completely normal life with only onekidney; indeed, some people are born with only one kidney. If akidney is removed, the remaining kidney increases slightly in sizeand capacity, and can carry on the function of two kidneys. Thismeans that it is possible to remove one kidney from a healthyliving person and transplant it into someone who needs it, withminimal ill effects on the donor other than the surgery itself.

“One of the

most frequent

concerns of potential

living kidney donors is

whether the loss of one

kidney will adversely

effect them in

later life.”

A wide range of people canconsider becoming a livingdonor for a loved one. Theseinclude a close relative,spouse, partner, or closefriend who has demonstrateda long-standing emotionalrelationship with the recipient.

Donors are usually brothers,sisters, partners or parents ofthe recipient, and, less often,they are relatives such asuncles, aunts, grandparents,sons or daughters.

Pressure on the donor from other family memberscan be an issue. There may be pressure to donate akidney to a family member who is unwell, even if thedonor is not entirely sure that it is the right thing forthem to do.

For donors, it is therefore important to considerall these issues before you even volunteer forthe initial tests. It can be harder to think clearlyabout the issues once, for example, you are told thatyour kidney could be a suitable match for therecipient.

PEER PRESSURE

WHO CAN DONATE A KIDNEY?

RELATIONSHIP

Potential donors should preferably be 25 years of age though in some circumstances donors agedfrom 23 years may be considered. There is no strict upper age limit for potential donors, but anolder person is less likely to pass the medical examination for potential donors, given that advancingage can bring more medical issues. The outcomes are generally better for recipients when the donoris similar in age to them. Similarly, a slight person who is of low body weight might not be the bestdonor for a large person of strong build. Each case will be considered on an individual basis by thetransplant team and decisions made accordingly.

AGE AND WEIGHT

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Although one might think that most familymembers would want to give a kidney, life is notalways so simple. Donation between siblings, forexample, can present a variety of family andemotional issues.

The problems are usually less complex forparents donating to children, but even here,loyalties may be divided between a desire toprovide for one child, whilst inevitably deprivingother children of one parent for a period oftime.

FAMILY ISSUES

This is not a trivial consideration, since thetransplant operation might come after a long illnessfor the affected child, during which time otherchildren may have felt deprived of their share ofparental love.

Parents, as with all donors, must also face up tothe possibility that the kidney might not function.This can be a very difficult complication for bothdonor and recipient.

Finally, there may be conflict between theparents as to who should give a kidney.

The transplant team is fully aware of allthe issues (psychological or otherwise)involved in living kidney donation.

Therefore it is very important that,before volunteering, and throughoutthe assessment process, closemembers of the family fullyunderstand the process and considerall the risks and implications.

It is important to openly discusshow everyone feels, especially howpeople might feel if the kidney wereto fail and the disappointment thatmay cause.

It is also important to consider thefinancial implications of donation,such as salary protection whilst out ofwork, life insurance, and mortgage

repayments. Recently the governmenthas introduced a scheme to reimburse some out-of-pocket

expenses associated with being a living kidney donor.For further details on this scheme see page 30-31.

THE TEAM’S PERSPECTIVE

P.7

Individuals volunteer to donate a kidney fora variety of reasons. Often donors aremotivated by watching someone close to

them wait a long time for a transplant orseeing a loved one suffer in some way as aresult of kidney problems.

Other reasons for wanting to donate akidney include feeling a duty to do somethingfor a loved one who is unwell or feeling that itwill benefit the donor’s life to have their lovedone free of dialysis. Research has shown thereasons for donating can vary, as shown in thechart below.

CHAPTER 2

WHY BECOME A LIVING DONOR?While all these motives might be acceptablereasons to be a donor, more complex reasonscan also be involved, such as:l Offering to donate a kidney because of feeling

pressure from others (e.g., family members),perhaps because the situation seems urgent, orit appears that the ill person has no otheroptions.

l Offering to donate because of feelings of guilt,or feeling that it is your duty as a close relative/friend.

l Offering to donate to “right” past wrongs, tofeel good about yourself, or to feel closer to the

person to whom you are donating.

Most people have a number ofreasons for donating, and it is

normal for different issues tocome up when you are thinking

about becoming a donor. It isimportant that these arediscussed openly duringyour donor work-up, andthis discussion forms partof your meeting with theteam, particularly thepsychologist.

Desire

to help

Feeling of

moral duty

Pressure

Logic

Self-

benefit from

recipient’s

improved

health

Identification

with

recipient

Increased

self-esteem

Volunteering

to donate

“Individuals volunteerto donate a kidney

for a variety ofreasons.”

P.8

Direct personal communication isthe key to making sure the processof assessment for living kidneydonation goes smoothly. This is trueboth for donors and for recipients.

If you want to be considered as apotential kidney donor, for a friendor family member, you will need tomake direct contact with the KidneyTransplant Office at BeaumontHospital and ask to speak with oneof the Kidney Transplant Co-ordinators.

Phone number is 01-852 8397.

It is important to be aware thatwe will not commence theevaluation of a potential livingdonor until the recipient has beenevaluated by the transplant team.This usually means that a potentialrecipient must be suitable for transplantand must be on the active waiting poolfor a deceased donor kidney. It isimportant to discuss your wish todonate a kidney with the potentialrecipient, since we cannot evaluate apotential donor until we have theconsent of the recipient to do so.

WHAT MAKES A SUITABLE LIVING DONOR?

Most people are familiar with the fact that red blood cells have a specific type or group: A, B, AB, or O. In general , for successful direct transplantation, the blood group of the

potential donor must be compatible with that of the proposed recipient. So, before anything else, theblood group compatibility of donor and recipient must be tested.

The different pairs are shown below:

Before the medical staff can agree to anyone becoming a living donor, they must be satisfied thatthe donated kidney is unlikely to be rejected by the recipient’s body. They also need to ensure thatthe person, willing to be a donor, is unlikely to suffer ill health as a result of making the donation.

HOW CAN I VOLUNTEER?

BLOOD GROUPS

Recipient

Blood

Group O

Donor

Can be

O

Recipient

Blood

Group A

Donor

Can be

O or A

Recipient

Blood

Group B

Donor

Can be

O or B

Recipient

Blood

Group AB

Donor

Can be

O, A, B,

or AB

If you are not acompatible bloodgroup with yourrecipient it is stillpossible to donate akidney to help yourloved one by way ofpaired kidneyexchange.

See page 27-28or ask yourtransplant co-ordinator todiscuss this withyou.

P.9

Tests to check the donor for viruses arecompleted quite early in the assessment

process. A potential donor’s blood isexamined for the presence ofprevious exposure to certain viruses,such as Hepatitis B & C, HIV and

Cytomegalovirus (CMV). With the exception of CMV, if these viruses are

detected, transplantation cannot normally takeplace due to the risk of disease transmission.CMV can be transmitted during transplantation.Recipients can be affected with flu-like symptomswhich can usually be controlled by modern anti-viraldrugs.

In summary, donors generally need to meet thefollowing standards;l Donors need to be fit enough to undergo the

operation.l They need to be capable of living normally with

just one kidney.

l They must be in excellent physical health.l Their medical history needs to be relatively

“clear” or uneventful.l They must be relatively free of pressure to

donate as well as having a positive relationshipwith the potential recipient.

l They must have some positive coping skills andsupportive relationships.

l They must be relatively free of current emotionaldistress or disturbance.

l They must demonstrate a clear and realisticunderstanding of what is involved in livingkidney donation.If tests show evidence of poor kidney function

or, if investigations show the possibility of thedonor being medically unsuitable, the offer of adonation may be declined. The teamrecognises that this can be difficult newsfor those who are motivated to donate akidney to a loved one.

TISSUE MATCHING

Once blood group compatibility has been confirmed,the donor has to be tested for tissue compatibility.The tissue type of the donor and recipient will bedetermined in the transplant laboratory by way of ablood test. This process may take up to six weeks. Ingeneral, the better the match between the recipientand the donor the better the long-term success ofkidney transplantation.

You are tested for HLA antigens on up to 12different markers, which can have thousands ofdifferent combinations. A donor recipient pair thathas matches on each of these 12 markers has aso-called ‘full house match’, sometimes called ‘zeromismatch’. Donor recipient matching is importantbecause a better match often results in bettersuccess of the transplant, and because poormatching can make kidney transplantation, thesecond or third time, a lot more difficult.

OTHER BLOOD TESTS

The long-term success of a kidneytransplant can be excellent, even whenthe donor and recipient tissue-match isless than perfect.

P.10

RISKS AND BENEFITS

CHAPTER 3

BENEFITSl The main benefit to the recipient of a successful kidney

transplant is usually freedom from dialysis, energylevels returning to normal and feeling ‘well’ again.

l Although a transplant recipient will always have to takemedications to prevent the rejection of the kidney, mostaspects of their lives can return to normal. Themajority of recipients return to their normal activities ofdaily living and even full-time work.

l Long-term kidney transplant survival rates are verygood for kidneys from living donors, often lasting10 – 20 years.

l In general, the only way a patient with severe kidneydisease can avoid a long period of time on dialysisis if they have a willing and suitable living donor. Thisvaries slightly but the average is 35 months. A livingkidney transplant can sometimes be organised in 4 to 6months and may be planned prior to the person actuallystarting dialysis.

FOR THE RECIPIENTS

\RISKSl As with any surgical procedure, there are risks

for transplant recipients. This includes the riskof death, which is less than two to three casesper thousand living transplant recipients.

l Poor blood supply to the kidney or severerejection can cause failure and greatdisappointment to everyone. It is estimated,however, that 95% of living kidney transplantsare still functioning at one year and manypatients are fit and well twenty years aftersurgery.

l Relationship and emotional problems canarise within the family for the potentialrecipient as well as the donor. Potentialrecipients may feel under pressure fromother family members – even the donor – togo ahead with the procedure. It is a topicthat needs to be discussed, at length, withall members of the family. The recipientmight feel a sense of guilt about the donorand this needs to be recognised and spokenabout.

P.11

l One of the most common emotionalchallenges a recipient may face is fear –particularly fear that the transplant willnot work out. This can be especiallydifficult for recipients as they are aware thatthe donor has made a sacrifice on theirbehalf. By discussing these issues as openlyas possible, difficult situations such as thetransplant not working out can be handled ina sensitive and supportive way by allinvolved.

FOR DONORS

BENEFITS l A potential donor is likely to have experienced

some changes to their own lifestyle due to afamily member’s illness (e.g., as a sibling thesecould include greater domestic responsibilities).A successful kidney transplant may mean thebalance of roles/ responsibilities change in apositive way in a family, when a formerly illperson may be able to contribute more to familylife.

l Spousal transplantation offers the potential forconsiderable improvement in quality of lifefor both parties; if the transplant is a successspouses and families are free of the burden ofdialysis.

l The main benefit of donating a kidney ispurely an emotional or psychological one.The sense of satisfaction, at giving a lovedone a kidney, can sometimes be thoroughlyrewarding for the donor.

RISKSl Approximately one in eight donors who

come forward to be tested will be consideredsuitable as an actual donor. Donors who havegone through testing and found to be unsuitablemay be left feeling helpless and disappointed.

l Any patient who has a general anaesthetic or amajor operation runs a slight risk of problems,though the tests that are done before the

operation try to ensure that this risk is made assmall as possible.

l The removal of a kidney involves a rather moredifficult and uncomfortable operation thanthe transplant operation. It involves a degree ofpost-operative pain and discomfort which can bepartly controlled by painkillers. The potentialdonor should keep in mind that they are likely tofeel less well than the recipient in the first fewweeks after the operation.

l The tests involved in the process could reveal anabnormality or health problem that the donorwas unaware of before volunteering as apotential living donor.

l After the operation, the donor may experiencea sense of anti-climax and may be at aslightly higher risk of depression, particularlyif he or she or the recipient has post-operativeproblems.

l An emotional difficulty for the donor may be theworry around how they will face their futurewith one kidney; the donor may worry that theydo not have the ‘assurance’ of the second, in caseof serious accidents or illness.

l The risk of the surgery not working out needs tobe seriously considered. As we know, no matterhow many tests are undertaken beforehand,there is still a risk that the transplantedkidney will fail and the recipient will have toreturn to dialysis.

l Young women need to consider if they shouldpostpone being a kidney donor until after theyhave had their family. There is evidence thatwomen who have donated a kidney are morelikely to have high blood pressure or pre-eclampsia in subsequent pregnancies.Nonetheless most kidney donors will havesuccessful pregnancies after donating a kidney.

l There is a possibility that, as a result of tissuetype testing, we will discover that one of yourparents or other potential donors is not in factyour blood relative. You need to think about howyou could cope with this news before you embarkon becoming a living kidney donor.

P.12

IN SUMMARY, THE MAIN RISKS OF THE SURGERY FOR DONORS ARE AS FOLLOWS:

1. The risk of death (estimated to be approximately 1 in 1600 – 3300 cases).

2. Negative reaction to anaesthetic or other drugs.

3. The general complications of major abdominal surgery:a) Blood clotb) Intra-abdominal bleeding and infectionc) Wound complicationsd) Chest complicationse) Urinary retention/urinary infectionf) The possible need for blood transfusionsg) Risk of adhesions and blockage of the bowel

4. The possibility of short and long-term wound pain.

5. The need for a recovery period of between 4-12 weeks. Potential donors shouldcheck their sick leave entitlement with their employers.

6. The possibility of increase in blood pressure and protein in the urine.

7. The possible emotional consequences of donation: the risk of the donor feelingpressure from family, feeling worried about the future with one kidney, or feeling upsetafter surgery.

8. The possible family and relationship consequences of donation: the risk thattensions can arise in families around the surgery or that the balance in a donor-recipient relationship can change after surgery (e.g., a recipient feeling like they “owe”something or are indebted to a donor).

9. The emotional and psychological impact on the donor of the recipient dyingsuddenly or the transplanted kidney failing.

10. Young women should consider if they would prefer to donate a kidney after they havehad their family

11. The risk that surgery may impact on the current or future insurability of the donor.This has to be checked by the donor with their own insurance agency.

PROCEED TO TRANSPLANTATION

Final Cross Match

Independent Assessor

P.13

CHAPTER 4

LIVING DONOR EVALUATION STAGES

l Tissue typing results take approximately sixweeks to process and are reviewed at a largemeeting of different professionals.

l Once your tissue typing results are available, youwill be phoned by a co-ordinator to advise you ofthe results. You will be offered an appointmentfor a one-day donor assessment. This will involveyou coming to Beaumont hospital and having ana lot of blood and urine tests and a number ofscans.

INITIAL DONOR ASSESSMENT AND INFORMATION SESSION

THE FOLLOWING IS A SUMMARY OF WHAT HAPPENS, AT THE BEGINNING OF THE JOURNEYTOWARDS BECOMING A LIVING KIDNEY DONOR:

l The potential donor contacts the transplantco-ordinators’ office for general discussion ofliving kidney donation. The donor’s blood groupcompatibility is now assessed and he or she isgiven the living donor information book. Bloodmay also be taken for tissue typing tests. You willbe encouraged to watch the living kidneydonation video. You should watch this video onwww.beaumontkidneycenter.ie before youcome to the clinic for evaluation.

A summaryof the

variousstages of

assessmentinvolved in

theevaluation

of potentialliving

donors

Surgical Review

CT of Abdomen

HLA (tissue type) Compatability

ABO Blood Type Compatability

Interested Donor

contd next page

1 Day AssessmentTO INCLUDE NEPHROLOGY, SOCIAL WORKER AND, ON OCCASION, PSYCHOLOGY REVIEWS,

BLOODS AND CT SCAN ALL ON SAME DAY

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ONE DAY DONOR ASSESSMENT Once you have been identified as potentially suitable to be akidney donor you will be invited to come to Beaumont Hospital fora detailed assessment. During this busy day you will have manytests done and meet many members of the transplant team.

DETAILED POTENTIAL DONOR ASSESSMENT

After the initial assessment and information session, thefollowing stages are usually

followed as part of the detailedevaluation of potential

living donors

l A transplant nephrologist(kidney doctor) evaluatesthe donor with a full historyand physical assessment. Theyagain discuss in detail the risksand benefits of living donorkidney transplantation.

l A transplant co-ordinatorarranges for the followingtests to be performed:

Multiple blood and urinechemistry tests.Blood testing forviruses includinghepatitis and HIV(AIDS) test andsyphilis test. At thisstage a second tissuetype test will betaken. Chest x-ray,abdominal ultrasound,CT scan of kidneys

contd...

and ECG. You will also have aspecial test called an IsotopeGFR test. In this special test, toprecisely measure your level ofkidney function, a very smalldose of radiation will beinjected into to you and thenover the subsequent 4 hoursyou will have blood tests drawnto carefully measure the levelof kidney function you have.Any special investigationsare also ordered at this stage.

l You will meet with the SocialWorker who will inform youabout the Living Organ DonorReimbursement Scheme. TheSocial Worker will also discusssome of the practical, financialand emotional issues that mayarise throughout the donationprocess.

You will be examined by akidney specialist and havean opportunity to discussany aspect of this duringthis meeting. You need tothink carefully how youwant to receive theseresults. If, for example,you hear in the presenceof your other familymembers that you are theonly potential donor, youmight feel great pressureto proceed with donation.In the first instance, thenephrologist will onlydiscuss your resultswith you. They will notdiscuss them with anyother family member.

l Once results are given,the donor who wishes toproceed is asked tocontact the transplantoffice for an appointmentto start work-up as apotential donor.

l It is important to realisethat if you are not directlycompatible to donate toyour loved one it maystill be possible to do thisby way of paired kidneyexchange or desensitis-ation. See page 27-28.

Outpatient Clinic

CT Angiogram

P.15

l Depending on your particularsituation you may be offeredan appointment to meet ourtransplant psychologist ortransplant psychiatrist.

l After this one-dayassessment all yourinvestigations will bereviewed by the transplantteam. The team may wellrequest other specific follow-up tests.

l Potential donors are thendiscussed at the multi-disciplinary meeting.If everything is satisfactorythey are referred to the donorsurgeon.

“The donor has anothermeeting with his or hersurgeon and a date for

surgery is booked.”

l The potential donor isreviewed by the donorsurgeon andanaesthetist.

l The donor is reviewed bythe IndependentAssessor.

l Final tissue typing tests arecompleted. Consent formsfor surgery are signed and adate for surgery is agreed.

INDEPENDENT ASSESSOR INTERVIEW

All donors and organ recipients are required to see anIndependent Assessor (IA) who is a person trained intransplantation but independent of the Transplant team. The IAinterviews the donor and recipient separately, and together, and isindependent of the healthcare teams who are involved in thedonation process.

The purpose of these interviews is to ensure that donors are notforced to do something against their wishes, to ensure that noreward has been sought or offered and to ensure that the donorhas the capacity to make an informed decision.

Depending on complexity, most interviews range in time from30 minutes to one hour. Donors and recipients will be asked tobring proof of their identity and proof of their relationship.

These interviews take place after the donor has been approvedfor donation at the multi-disciplinary team meeting. The decisionof the Independent Assessor is final and is not subject to appeal.

Before the living kidney transplant surgery, both donor and recipient have to agree that they wantthe surgery to proceed. All test results will then be reviewed by the multi-disciplinary consensusteam.

This team consist of the consultant transplant surgeons, nephrologist, immunologists, anaesthetists,transplant co-ordinators, psychologist, psychiastrist and social worker. It is only when the results of all thetests are approved by this group that you will be referred to the independent assessor. Once theindependent assessor gives approval a date will be set for surgery and consent forms signed.

P.16

CHAPTER 5

WHO MAKES THE FINAL DECISION?

KIDNEYDONOR

Nephrologist

Surgeon

Anaesthetist

Immunologist& transplant

scientist

Psychologist

Physiotherapist

Transplant

Co-ordinatorNurses

DIFFERENT PEOPLE INVOLVED IN THE PROCESS

Social

Worker

Independent

Assessor

P.17

THERE ARE MANY DIFFERENT PEOPLE IN THE TRANSPLANT TEAMAND EACH HAS A SPECIFIC ROLE

TRANSPLANTCO-ORDINATORS

The Co-ordinator is responsible forensuring that the individualaspects of the donor’s care,including pre-donation assess-ments and the surgery itself, run assmoothly as possible. The co-ordinator is aware of what stage eachdonor is currently at in theirassessment, and whom is responsiblefor each part of the process. Simply put,he/she co-ordinates the differentaspects of the process, from initialassessment to post-operative care, toensure it runs as smoothly as possible.

The consultant nephrologist is the person who, together with the consultant transplant surgeon, hasto be sure that the transplanted kidney is likely to restore the health and reasonable lifestyleof the intended recipient and that the donor’s health would not suffer as a result.

Donors and recipients will generally each have a different nephrologist.

TRANSPLANT CO-ORDINATORSGrainne Lambe, Aileen Counihan and Laura Donovan

CONSULTANT NEPHROLOGIST

Prof. Peter Conlon, Dr. Mark Denton; Dr. Conall O’Seaghdha; Dr. Declan DeFreitas and Dr. Colm Magee

P.18

PSYCHOLOGIST

Many important emotional relationship issuesneed to be considered in a living kidney donation.The psychologist is there to discuss these withthe potential donor and offer support to donorsat any stage in the process.

The psychologist also has responsibility forconsidering whether a potential donor is underundue pressure or stress in relation to donation.

The psychologist also examines whetherpotential donors are currently emotionallystable and how they are likely to cope with majorsurgery.

The Social Worker

will explain the

Reimbursement

Scheme and discuss

and offer support

around the practical,

financial and

emotional aspects

of the donation

process.

SOCIAL WORKER

Tara PowerSocial Worker

A team of senior transplantsurgeons, one for the donor and

one for the recipient, with anothersurgeon to assist, will perform the

operation.The transplant surgeons must

ensure that all the results of testspoint to a successful transplant.They must also be sure that the

donor and recipient are fit toundergo surgery with the minimum

risk.The surgeon who removes the

kidney carries overallresponsibility for ensuring the

safety of the donor.

TRANSPLANT SURGEONS

Ms. Dilly LittleSurgeon

Mr. Richie PowerSurgeon

Mr. Ponnusamy MohanSurgeon

Mr. Gordon SmythSurgeon

P.19

After any form of surgical procedure, returning tofull activity can be an uphill struggle. Thephysiotherapist can frequently advise on methodsof making rehabilitation easier.

CONSULTANT IMMUNOLOGIST AND MEDICAL SCIENTISTS

It is unlikely that you will meet the consultantimmunologist and medical scientists, but there isa large group of people, in the laboratory, that are

members of the transplant team. These scientistsanalyse your blood in detail to maximise thechances of transplantation success.

It is the responsibility of the anaesthetist toadminister the anaesthetic and to ensure thehealth of both patients during the surgicalprocedure.

CONSULTANTANAESTHETIST

PHYSIOTHERAPIST

P.20

The body makes millionsof antibodies, whichare primarily intended

to fight off disease. However,when people have a bloodtransfusion, pregnancy,previous transplant or someinfections, they can produceso-called ‘HLA antibodies’which react with donortissue and possibly damageit.

It is therefore preferableto find a kidney againstwhich you do not haveantibodies.

You will hear the doctortalk about PRA orPGEN. This is ameasure of theprobability ofhaving antibodiesagainst 1,000Irish donors; it is ameasure of howhard it will be to finda suitable compatibledonor. If the recipient has aPGEN of 0% then they have no antibodies andshould not have difficulty finding a suitabledonor. Conversely, if the recipient has a PGEN of100%, they will have great difficulty findinga suitable kidney donor and will most likely

have a prolonged waiton dialysis. If therecipient has asibling, who is a‘perfect match’,then antibodies aregenerally notimportant. However,even patients with100% PRA can be

CHAPTER 6

THE SCIENCE IN MORE DETAIL

“If the recipient has a PGEN of 0%then they have no

antibodies and shouldnot have difficultyfinding a suitable

donor.”

WHAT ARE ANTIBODIES?

“If the recipient has a sibling

who is a ‘perfectmatch’, then

antibodies aregenerally notimportant.”

P.21

transplanted if the rightdonor comes along.

When the recipient seesthe transplant surgeon, atthe pre-transplantassessment clinic, they willbe told what their PGEN isand this will give themsome assessment of howlong the likely wait will beto receive a transplant.There are no effective strategies to take awayantibodies that give good long-term results.

The levels of antibodies in the recipient might fluctuate,and so it may be possible that the initial screening for donorspecific antibodies is favourable but, later screening in thedonor workup shows that the donor is not suitable. This cancause significant disappointment to the donor who may be

“The levels of antibodies

in the recipient may

fluctuate.”

“The process of checkingthe suitability of a donor isa long, but in-depth one.”

P.22

SUMMARY OF TESTS INVOLVED

A sequence of tests are necessary to thoroughlyexamine the health of the potential living donor andthe function and anatomy of the donor kidney. Apotential living donor can expect:

TEST PURPOSE

Blood Pressure Excludes high blood pressure.

Urine Analysis Identifies any underlying conditions.

Blood Tests For routine analyses. Another blood test will be taken from both the potential recipient to check the recipient does not have antibodies which may react to the donor. This test will be repeated just before the operation.

Isotope Kidney If the kidneys are not functioning well, the creatinine level rises. In order toget a precise measure of the level of your kidney function a tiny dose ofradiation will be injected into you and then blood samples will be drawn forup to 4 hours later. This test gives a more precise measure of the level ofyour kidney function.

X-rays Ensures normal function, especially of the chest area.

ECG A cardiograph of the heart function is recorded to exclude heart disease.

Ultrasound Checks the size and shape of the kidneys and excludes any anatomical abnormalities.

Spiral CT Scan Looks in detail at the kidneys and look and blood vessels going to the kidneys. After this test, the surgeon will discuss with the donor which kidney is recommended for removal.

Function Test

in an advanced stage of the workup process. When testing donor and recipient

compatibility, one of the main problems thathas to be avoided is giving a patient akidney to which they have formedantibodies, as this carries a high risk for theearly failure of the transplant.

The process of checking the suitability of adonor is a long, but in-depth one. To be ascertain as possible that the transplant will besuccessful, for both recipient and donor, thisextensive procedure is necessary and alsogives the potential donor plenty of time to

WHAT ARE ANTIBODIES? contd.

P.23

SUPPORTS AVAILABLE AND DIFFICULTIES THAT CAN ARISE

CHAPTER 7

EMOTIONAL ASPECTS

As a living kidney donor, you volunteer to gothrough surgery that carries certain risksand might not be of any direct benefit to

you. This is why the living donor team go to suchlengths to ensure we are not putting you at anyunacceptable risk in agreeing to take a donatedkidney from you. It also means that the assessmentprocess is long and sometimes difficult. Thepsychologist is available to support you whenissues arise such as:l You change your mind about being

a donor because you realise beinga living donor is not for you, oryou are feeling too nervousabout the surgery. The donorteam recognises that this can bea difficult experience for potentialdonors, and they will do their best

to support you through the process, in such away that changing your mind would haveminimal impact on your relationships/family.

l You might be frustrated by the assessmentprocess, perhaps because you find the waitdifficult or you have other concerns.

l You feel worried about the surgery or aboutliving life with one kidney after surgery.

l Your offer of donating a kidney isdeclined because the team are concerned

about your medical suitability or the risksto your health. This can be a verydisappointing experience for potentialdonors, particularly if it happens afteryou have gone through a number of

assessments and your expectations havebuilt up.

“The

assessment

process is long

and sometimes

difficult.”

WHAT SUPPORT CAN I GET BEFORE TRANSPLANT SURGERY?

P.24

l The donor finding it difficult to be in theunfamiliar sick role. This can be especiallydifficult because the recipient often recoversmore quickly than the donor after thesurgery.

l The donor can sometimes feel an anti-climax or a sense of loss or sadness afterthe surgery. This is normal, and might bepartly due to the anaesthetic or the physicalexhaustion of surgery. It can also be a resultof feeling upset at being dependent andunwell in a hospital bed.

l The living donor may worry about thedonated kidney being rejected by therecipient’s body. If the kidney is rejected,donors can feel huge disappointment andeven despair and often need a lot of support.

“The psychologist is also availableto support you, because recoverycan bring up all kinds of issues for

donors and their loved ones.”

WHAT SUPPORT CAN I GET AFTER KIDNEY DONOR SURGERY?

If you get to the point of going through livingdonor surgery, the team will be there to lookafter you throughout the process.

The psychologist will be available to supportyou, because recovery can bring up all kinds ofissues for donors and their loved ones,including:

Of course, living donors can also experiencepositive outcomes from giving a kidney, including;l The practical benefits of not having a spouse

or child on dialysis: the recipient is more ableto get involved in family life.

l The ‘feel-good factor’ the donor getsknowing that they have made a positivedifference to someone else’s life, by donatinga kidney, and perhaps feeling closer to therecipient as a result of the surgery.

WHEN DIFFICULTIES ARISE...

For the most part, livingkidney donors do not regretgoing through the surgery.The research shows that for

most donors, one year aftersurgery there is no significant

change in their quality of life, self-reportedhealth, anxiety or depression.

A minority of people regret donatinghowever, and this is linked with a negativeoutcome for the donor and/or the recipient.Complications for the donor or the recipientleading to long-term consequences such as chronic

pain, place the donor at a slightly greater risk ofmental health problems (e.g., anxiety ordepression) because of the strain.

This also explains why it is important to donatefor the right reasons. A strong bond betweendonor and recipient can helpboth parties to get throughpost-operative difficulties,whereas if the relationshipbreaks down, the donor maybe left with regrets aboutdonating.

See also book six of thisseries -’Emotional Wellbeing’.

Under general anaesthetic, thedonor kidney is removed by anoperation in the same way as if the

kidney was diseased. Most surgeonsremove the kidney through an incision inthe side, other surgeons prefer to removethe kidney through an abdominal incision.The kidney is located at the back wall ofthe abdomen behind the bowel and thestomach.

Generally, for purposes of living kidneydonation, the surgeon chooses to removethe left kidney as it has slightly longerblood vessels, which facilitate thetransplant. Sometimes kidneys have morethan one blood vessel, or there may be aslight discrepancy in the size of the kidney,and, therefore, the right kidney might beremoved. The donor is always left with the “betterkidney” of the two.

If the left kidney is to be removed, the bowel isfirst put to one side out of the way and then thefat around the kidney is cleared away. The kidneyis mobilised and the artery, vein and ureter(drainage urine tube) are identified and dissectedfree.

Neighbouring structures to the left kidney arethe spleen, the adrenal gland, the pancreas, thecolon and small bowel and the stomach.

Neighbouring structures to the right kidney arethe liver, the adrenal gland, the inferior vena cava(a very large vein) and the bowel.

The surgeon takes great care not to injure any ofthese adjacent structures as they free up the

P.25

THE DONOR NEPHRECTOMY(Removal of kidney)

CHAPTER 8

THE OPERATION

kidney. They will then divide the ureter to go withthe donor kidney.

The artery, bringing blood to the kidney, comesoff the main artery of the body - the aorta.

The donor kidney vein comes off the main veinin the body - the inferior vena cava. When the bloodvessels are clearly identified and dissected, to givemaximum length by dividing any branches notsupplying the kidney, the surgeon first secures theartery, either by tying it off or stapling it shut. Thevein is then tied off in a similar fashion and thedonor kidney is removed.

Once the artery is tied off, the kidney is removedas quickly as possible, as the blood in the kidneycan clot while it is not circulating. Once the kidneyis removed, the surgeon checks that there are noareas of bleeding and then closes the wound.

Depending on the donor’s anatomyand preference and the surgeon’sdecision, the surgery might beperformed through an incision belowthe ribs or by a ‘keyhole’ incision. Theadvantage of the keyhole incision isthat it allows the incision to removethe kidney to be sited lower down inthe abdomen, which is generally notas sore post-operatively. Thisincision also allows the surgeon toplace their hand into the abdomen tofacilitate the dissection of thekidney.

However, if the keyhole method isadopted and the surgeon has toconvert to the traditional open surgical method, forwhatever reason, then the donor will have thestandard scar below the ribs and a second scarlower down on the abdomen. The surgeon’s firstpriority is always to ensure the safety of the livingdonor.

The kidney is lifted out of the wound and flushedwith a cold solution to wash out blood and slow themetabolism before being carried into the adjacentoperating theatre in which the recipient is waiting.

The incision(s) is/are then sewn up and thedonor is transferred to the recovery room and,subsequently, the ward. Sometimes a temporary

P.26

KEYHOLE SURGERY

drain is fitted near the wound. Fluids can beadministered via a drip, and because the incisioncan be painful afterwards, infusions of pain killerscan be added to this. Alternatively, the anaesthetistmay insert an epidual catheter to administermedication close to the spinal cord to help withpost-operative pain. This is usually removed on thesecond or third day post-operatively.

A catheter is inserted in the bladder. Tubes areusually removed, after the first day, and the donoris encouraged to get up and sit in a chair.

A donors stay in hospital is usually between 4-6days. He or she can expect to be out of bed the day

after the operation and home in lessthan two weeks. The stitches areremoved approximately 10 dayspost-surgery. The wound may remainsensitive for several weeks.

Sometimes a small area ofnumbness may be noticed on theskin of the abdomen, because smallnerves have been cut by the incisionat the side. However, the scar shouldbe the only permanent reminder ofthe donor operation. The donor willusually have to take 4 weeks offfrom work to recuperate, dependingon the individual and his or heroccupation.

ST DAMIEN’S RENAL TRANSPLANT WARD

P.27

DRIVING

CHAPTER 9

RESUMING NORMAL

There are no hard and fast rules with regard todriving again. In the main, if the donor feelsokay and their doctor agrees to it, a donor canreturn to driving when they feel capable –usually after 4-6 weeks. The donor must beaware, however, that long journeys could bedifficult and that he/she should not over-stretch.

There is no standard typicalperiod before sexualintercourse can beconsidered. Donors should beable to resume their usualsexual relationships as soonas they feel comfortable. Itmay take a few monthsbefore normal activities canbe undertaken, but thisdepends on the individualsand their recuperation.

SEXUAL RELATIONSHIPSEXERCISE

Maintaining a healthylifestyle is as important,after donation, asbeforehand. Any postdonation exerciseprogramme should beginslowly with the length oftime spent exercising,and the effort involved,being increased over aperiod of time.

FOLLOW-UP

After living kidney donorsurgery, an outpatient clinicappointment will be offered toyou, for follow-up at 6 weeksand 3 months, by the donorsurgeon. Annual follow-up willbe offered to you by a nephrologist closer to where you live.You will need to ensure that you make appointments forannual follow-up. You should bring blood and urine test resultswith you or have them done on the day you come to the clinic.

CHAPTER 10

The kidney is put into the outer pelvis – protected by the hipbone – low down and to one side of the bladder. The bloodvessels of the kidney are joined to the large blood vessels

supplying the leg. The kidney lies here away from the intestinesand their covering and the ureter can more easily be sewn into thebladder.

The recipient should be out of bed within a day or two. After onlya few days, most or all of the tubes will be removed. Medicines tosuppress the immune system will be necessary. These drugs helpthe recipient’s body to tolerate a ‘foreign’ organ. In the early stages,the medication may be in the form of infusions. Later this willchange to tablets. This medication will have to be taken, by therecipient, for the entire life of the transplanted kidney.

The most anxious time for both donor and recipient is the ‘waitto see’ if the new kidney functions well. Depending on howsuccessful the transplant has been, the recipient can expect to leave hospital between one and threeweeks post-surgery. By this time, he/she will usually be feeling the benefit of the kidney transplant.Initially, recipients will have to be seen quite frequently in the out patients’ clinic but this becomes lessfrequent as time progresses.

GENERAL INFORMATION

P.28

THE RECIPIENT’S TRANSPLANT

WHAT CAN I DO IF I AM NOT A MATCH?

If you are not a match for the recipient becauseof blood group or antibody reasons there are anumber of possibilities.

If the recipient is not highly sensitised(PGEN<70%) and has a blood group incompatibledonor, the best option to consider would be to enterinto a paired kidney exchange. That is where thepatient’s donor gives his kidney to a compatiblerecipient and another donor gives a kidney to ourpatient.

An example could be a brother who wants todonate a kidney to his sister but is unable tobecause of a difference in blood type. If this

recipient/donor pair consents to participate in thepaired kidney exchange programme, an attemptwould be made to match them with anotherrecipient/donor in the same situation willing to"exchange" kidneys. An example is if Mr. Jones whois blood type A wants to donate a kidney to Ms.Jones who is blood type B and another donor-recipient pair, Mr. and Mrs. Smith, have the oppositecircumstance (blood type B donor who wants todonate to blood type A recipient). The donor kidneycould be exchanged and both groups wouldundergo a transplant procedure which would nototherwise happen.

P.29

IN ORDER TO MAXIMISE THE POTENTIAL OF FINDING A SUITABLE MATCH WEPARTICIPATE IN A PAIRED KIDNEY EXCHANGE SYSTEM WITH THE UK. THEPOTENTIAL DONOR AND RECIPIENT MAY THEREFORE BE REFERRED TO AHOSPITAL IN THE UK OR BELFAST TO ENTERED INTO THE PAIRED KIDNEYARRANGEMENT.

If the recipient is highlysensitised (PGEN>70%)and they have an ABOincompatible donor butwell HLA-matched donor,it might be possible toenter into a programmeto remove the recipient’sABO antibodies andproceed ahead with thekidney transplant.

Some patients withhigh antibody levels mayhave to wait a long timeto obtain a suitable match. Effective technology does not currently exist to remove high levels ofantibodies to allow successful long-term outcomes.

MORE INFORMATION ABOUT PAIRED KIDNEY EXCHANGE

Paired kidney exchange allows the recipient to getthe best possible outcome from a donated kidneyby finding a kidney that he does not haveantibodies to. In this process the transplantnephrologist will refer the donor and recipients fileto a hospital in England or Belfast. Both donor andrecipient will then be invited to be reviewed by theUK transplant team.

The details of the donor and recipient areuploaded onto a UK computer system. Four times ayear the computer checks to find suitable matches.If a match is found you will be notified. It isimportant to realise that not everyone will find amatch and it may take a number of years before asuitable match is found.

Once a potential match is found both donor andrecipient will likely need some additional testing toconfirm suitability. It is also possible at this stage

that a difficulty will arise to stop the transplantgoing ahead.

If a suitable match is found both donor andrecipient will need to go to either the Belfast or UKhospital. Both donor operations will go ahead at thesame time to minimise the possibility of eitherdonor pulling out.

Once the donor and recipient have recoveredfrom the surgery they will return to Ireland forfollow-up.

It should be noted that there are financial andpractical issues to consider for patients who travelto England. In particular the donor and recipient willhave to spend a period of time in the UK as anoutpatient and they will have to organise their ownaccommodation. The Social Worker is available todiscuss any issues or concerns you may have andto provide you with support.

P.30

LIVING ORGAN DONORREIMBURSEMENT SCHEME

This scheme was introduced to address some of thecosts incurred by potential living donors participatingin the Living Donor Programme in Ireland, during the

pre-operative and post-operative period.The scheme applies to any potential donor who has been

invited to attend a one-day assessment, by the Living DonorProgramme at Beaumont Hospital, and those donors whohave been referred to the Paired Kidney Exchangeprogramme.

THE REIMBURSEMENT SCHEME COVERS THREE MAIN AREAS:l Travell Accommodationl Loss of earnings associated with organ donation

The scheme is currently under review by the Departmentof Health. Further details will be available on BeaumontHospital’s website...www.beaumontkidneycentre.ie orthe Irish Kidney Association’s website...www.ika.ie

Travel and accommodation expenses up to a maximum valueof €6,000 are reimbursable but such expenses must relateto a hospital visit/stay in relation to organ donation and mustbe supported by relevant documentation.

If a person donates, they may be entitled toreimbursement of earnings lost as a result of their inpatientstay for the purpose of donation and up to a maximum of12 weeks post-operative period. The amount reimbursableis capped at €6,000 and must be supported by relevantdocumentation.

An application form for the Living Organ DonorReimbursement Scheme can be obtained by contacting theLiving Organ Donor Reimbursement Scheme Office on056-7784579 or 056-7784551.

In cases where a donor is selected but later deemedunsuitable he/she can claim reimbursement for this periodonly.

P.31

continued on page 32

1. WHAT DOES THE PROGRAMME AIM TO ACHIEVE?The purpose of this scheme is to address theissue of the costs incurred by donorsparticipating in the Living Donor Programme inIreland during the pre-operative and post-operative period. The implementation of thisscheme is intended to minimise financialdisincentives for potential living donors, witha view to ensuring the pool of living kidneydonors continues to expand.

2. WHO IS ELIGIBLE FOR REIMBURSEMENTUNDER THE SCHEME?This scheme applies to any person who hasbeen selected as a potential donor (i.e. toattend the one-day assessment) by the LivingDonor Programme at Beaumont Hospital andto those who, under the clinical supervision ofthe National Renal Transplant Programme inBeaumont, travel to the UK for a paired kidneydonation (reimbursement for any expensescovered by other agencies in the UK will not bemade).

3. FOR WHAT PERIOD CAN I CLAIMREIMBURSEMENT?Eligible expenses will be considered forreimbursement from the time the donor isselected as a potential donor through to thein-patient stay for the donation surgery and fora 12 week period post-donation. In caseswhere a donor is selected but later deemedunsuitable he/she can claim reimbursement fortravel and accommodation for this period only.

Living Organ Donor

Reimbursement

Scheme4. AM I ENTITLED TO A REIMBURSEMENT

FOR LOSS OF EARNINGS ASSOCIATEDWITH ORGAN DONATION?If a person is selected as a donor they may beentitled to reimbursement for earnings lost asa result of their inpatient stay for the purposeof donation and up to a maximum of a twelveweek post-operative period. Such payment aresubject to compliance with the requirementsset out in the patient information leaflet,which can be obtained by contacting the LivingDonor Reimbursement Office on 056-7784579 or 056-7784551. The amountreimbursable is capped at €6,000 on theprovision of relevant supportingdocumentation. Please refer to the patientinformation leaflet, in relation to what isreimbursable regarding earnings.

5. WHAT OTHER EXPENSES ARE COVEREDUNDER THE SCHEME?Travel and accommodation expenses up to amaximum value of €6,000 are reimbursableunder the scheme. Such expenses must relateto a hospital visit/stay in relation to organdonation and must be supported by relevantdocumentation.

6. WILL MY PARTICIPATION IN THEPROGRAMME EFFECT MY DEPARTMENT OFSOCIAL PROTECTION PAYMENTS?A donor who is in receipt of a payment fromany Department of Social Protection Schemewill continue to have this payment made(provided such payments are in line with their

normal rules and regulations) for a period ofup to 12 weeks from donation. The LivingDonor Programme at Beaumont Hospital willmake the necessary arrangements with theDepartment of Social Protection inconsultation with the donor.

7. HOW WILL I RECEIVE MY REIMBURSEMENT?Payments will be made directly into thedonor’s bank account. In the case ofreimbursement for loss of earnings, whereverpossible, payments will be made in line

with the donors regular pay cycle i.e.weekly/ fortnightly/monthly. Claims for travelor accommodation will be processed within30 days of receipt in line with Prompt PaymentLegislation.

8. HOW DO I APPLY FOR REIMBURSEMENTUNDER THE SCHEME?An application form for reimbursement underthe scheme can be obtained by contacting theLiving Organ Donor Reimbursement Schemeoffice on 056-7784579 or 056-7784551.

9. WHO SHOULD I CONTACT FOR MOREINFORMATION ON THE SCHEME?You can contact the Living Organ DonorReimbursement Scheme office betweennormal office hours from Monday to Friday

All correspondence should be addressed to: LIVING ORGAN DONOR REIMBURSEMENT SCHEME OFFICE,

ST. CANICE’S HOSPITAL COMPLEX, DUBLIN ROAD, KILKENNY.

Contributors We would like to extend special thanks

to the following members of the Renal Team at Beaumont for their contribution to this book:

Peter Conlon, Aileen Counihan, Phyllis Cunningham,

Mark Denton, Molly Eng, Diane Gillan, Mary Keogan,

Dilly Little, Colm Magee, Olive McEnroe,

Siobhan McHale, Louise McSkeane, Ruth O’Malley,

Derek O’Neill, Tara Power

Kidney Cartoons: KegKartoonz (Noel Kelly)

Living Organ DonorReimbursementScheme contd. from page 31

P.32

l Families of renal patients from outside Dublin.It is available to all renal families no matter whatDublin hospital their family member isattending.

l Renal patients who have to travel longdistances to see their consultant as anoutpatient may stay overnight whenaccommodation is available.

l The Centre arranges counselling service asrequired by outpatients and their families. Thecounselling service is located at Donor House.

l Preference for accommodation is given tofamilies of patients receiving transplants andfamilies of the seriously ill.

FACILITIESThirteen en-suite bedrooms some of which can

sleep up to four persons. All rooms are on groundfloor level. All rooms have satellite TV, hairdryer,refrigerator and ironing facilities. There is directcontact with the hospital ward. Comfortablesittingroom/dayroom with satellite TV. Fully fittedkitchen where meals can be prepared by residents.Complimentary tea and coffee is provided by theAssociation for residents and guests. Soft drinksand snacks available from vending machine.Laundry room with washing powder supplied.Parking for overnight residents only.

The Centre is owned and funded by the IrishKidney Association. Donations from residents andfundraising initiatives are most welcome.

The Centre is open to residents all yearround. Day facilities are available Monday toFriday from 8.30am to 4.30pm, Saturday andSunday 12pm-4pm.

IRISH KIDNEY ASSOCIATION RENAL SUPPORT CENTRE

The Irish Kidney

Association Renal

Support Centre is located

in the grounds of

Beaumont Hospital, just

100 metres walk from

the main hospital

entrance, is open all year

round and provides free

accommodation for all its

residents, who include:

For further information contact: IKA Renal Support Centre, Beaumont Hospital, Dublin, D09 Y5R3.

Telephone: 353-1-837 3952. Out of hours (Emergency only): 087-416 9907Email: renalcentre@ika.ie

P.33

P.34

Contact Numbers

Beaumont Hospital 01-809 3000

Transplant Co-Ordinators 01-809 3119

St Peter’s Ward 01-809 2285/2290

St Mary’s Urology 01-809 2292/2293

St Damien’s Ward 01-809 2294/2761

Renal Day Care 01-809 3144

Patient Care Co-Ordinators 01-809 2727

Renal Nurse Counsellor 01-809 3931

Ambulatory Nurse Specialist 01-852 8395

Prof Conlon’s Secretary 01-809 2747

Dr Magee’s Secretary 01-797 4701

Dr Denton’s Secretary 01-809 3080

Dr de Freitas’s Secretary 01-809 3357

Dr. O’Seaghdha’s Secretary 01-809 2567

Home Therapies 01-852 8152

BEAUMONT RENAL UNIT – www.beaumont.ie/kidneyinfo

IRISH KIDNEY ASSOCIATION – www.ika.ie

IRISH HEALTH WEBSITE – www.irishhealth.com

AMERICAN ASSOCIATION OF KIDNEY PATIENTS – www.aakp.org

NATIONAL KIDNEY FOUNDATION USA – www.kidney.org

Other sources of useful information

P.35

USE THIS PAGE TO RECORD ANY QUESTIONS YOU MAY HAVE FOR YOUR DOCTOR

OR ANY MEMBER OF THE TEAM.

Notes

The need for equipment to maintain the smoothrunning of our wards and assist patients in theirrecovery is ongoing, as is the need to replaceand invest in new technical and operatingequipment which is vital to helping us maintainand save precious lives.

Beaumont Hospital Foundationworks toencourage and inspire private donations toBeaumont Hospital. The funds we raiseannually are used to bring about improvementsin patient care.

l We fund equipment and services across thehospital.

l We work closely with hospital staff to helpidentify and support new projects.

l We work with the hospital�s donors to supportfundraising initiatives for the hospital.

l Our team is involved in driving our annualcalendar of fundraising events.

l Co?ordinating our national raffle campaigns,and

l Promoting the reputation of BeaumontHospital as an expert medicalfacility.

Recent major projects which the Foundation hascompleted include the build of a new DayHospital for Care of the Elderly, at St Joseph�sHospital in Raheny (managed by BeaumontHospital). Thousands of our supporters and onemajor donor contributed to raising the entire

Beaumont Hospital FoundationBeaumont Hospital, Dublin, D09 V2N0Tel: 01?8092161 | Email: hello@beaumont.iewww.beaumontfundraising.ie CHY No: 11538

Every year, we care for over 420,000 sick and injured people, makingBeaumont Hospital one of the busiest medical facilities in Ireland