Monday 23 April 2018

Rude health: transplant woes

Ireland's dialysis patients urgently need New Kidneys on the Block, says Maurice Gueret, as things can only get better

Dialysis patients urgently require new kidneys.
Dialysis patients urgently require new kidneys.
Dr Maurice Gueret.

April kicked off this year with Organ Donor Awareness Week. The Irish Kidney Association used the opportunity to urge the Health Minister to consider using a second hospital for renal transplants. It's an interesting idea.

Currently, Beaumont is the only hospital in the State that provides this complex service. They also assist some patients to travel to the UK for NHS treatment under the Paired Kidney Exchange programme. But there is another hospital in Ireland that does kidney transplants, and quite a few of them, too. On one single day last September, transplant surgeons at the impressive 900-bed Belfast City Hospital carried out a whopping five kidney transplants all in one day.

Starting at just after midnight on a Sunday morning, a team of 14 doctors and 20 nurses worked almost 23 hours to transplant five kidneys into five Northern Irish patients who had all previously been on dialysis. All the patients were home by the following Monday week. Five kidney transplants in one hospital in one day is not a Guinness world record, but it came close to that feat, which stands at six. I'm not convinced we need a second kidney transplant unit. The unit we have could do with extra resources, but more cross-border cooperation between health ministers of the two jurisdictions on this island might also improve the situation for this country's 2,000 dialysis patients. The key to more transplants is more donations, whether it's the general populace donating organs after death, or living relatives donating a spare kidney to loved ones whose filtering has failed. There is no waiting list for the living donor assessment unit in Beaumont. And they should be receiving a lot more phone calls than they are at (01) 809-2298.

Chemists are falling over each other these days to be nice to customers. They want to collect your prescription from the doctor, organise your tablets in trays, review your medication history, deliver medicines to your house, text you reminders to take them and match competitors' prices. Soon they could be offering to put your suppositories in! It's a competitive market out there. Many smaller outlets have joined chains, which allows them buy cheaper, in bulk, and spend more on marketing. It's no closed shop anymore and Ireland is probably overstocked with pharmacies. We have one community pharmacy for every 2,500 people in Ireland compared to one GP surgery for every 3,000. That makes your prescriptions a valuable commodity.

My antennae also tell me that there is a lot more shopping around going on than there used to be. Social media is helping to make consumers more aware of price comparisons. A medical colleague rose the temperature recently when she tweeted a picture of a bottle of Nurofen syrup on sale in Mayo. The price tag on it was a shocking €13, shocking because the doctor happened to know that the price just over the border was little more than £3. No wonder some over-the-counter medicines are delivered with a smile.

April is a big month of celebration in south Co Dublin as the Blackrock Clinic gears up for its 30th birthday party. I was half way through medical school when the swanky private hospital was born, and remember thinking that American-style treatment had arrived here in Ireland. The Clinic attracted many of the top physicians and surgeons in the city, and, in its 30 years, has amassed an impressive array of achievements, particularly in radiology and cardiology. Blackrock Clinic introduced PET scanning to Ireland in 2001, and five years later began CT scanning of the heart. They replaced an aortic valve using a catheter in 2008 and three years later were using minimally invasive surgery to repair the mitral and tricuspid valves that lie deep in the heart. I have yet to sample the delights of its treatment, but on visiting I am always impressed by its compact design, ease of access and the absence of endless corridors. In my next life I'd quite fancy coming back as a hospital architect to give Ireland a taste of more high-rise medicine.

I'm always interested to hear your accounts of surgical practices and surgeons of yesteryear. One correspondent tells me about two treatments he had many moons ago in Sir Patrick Dun's Hospital. In 1950 his tonsils were taken out by a Mr O'Brien, and in the late 1960s he returned to the operating theatre of the same surgeon to have his sinuses scraped. He recalls his surgeon as being a bit stuffy. Brian O'Brien was a well known ENT man who qualified from UCD in 1935. He passed away in the late 1970s. It was said that he was popular among colleagues as he had a reputation for keeping fees up and always getting paid for his work! His waiting room had reading material about the death of a child during tonsillectomy as he didn't want patients or parents to think that it was always an easy operation. Mr O'Brien once attended a surgical conference in London where he overheard a careless remark about 'the Irish bombers' having arrived. He demanded and received a full apology before the meeting was able to get underway. Anyhow, the day after the sinus job mentioned above, my correspondent woke with a nose stuffed full with cotton wool and quite severe pain. Mr O'Brien came in. He asked the patient if he knew why Dean Martin pitied anyone who didn't drink. He didn't. Surgeon O'Brien explained that when teetotallers wake up in the morning, they know they are not going to feel any better for the rest of the day! His roundabout message was clear. Things can only get better.

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

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