How I gave my brother a living legacy... one of my own kidneysBy George Plumptre
Last updated at 9:31 PM on 01st August 2009
On March 20 this year, at the age of 53, I underwent an operation to give my young brother Francis a kidney.
It was a journey into the remarkable world of transplant surgery and living donorship which is, in these days of so much criticism of and despair about our health service, a beacon of positivity and quality.
Living-donor nephrectomy is a unique procedure because the donor makes a conscious, voluntary decision to give away their kidney and undergo major surgery that is not necessary.
Brothers Francis and George Plumptre
Transformed: Francis Plumptre, left, felt better immediately after receiving the kidney from George
It also comes with an element of risk to your own life, of unexpected illness, considerable short-term pain and no long-term physical benefit.
Francis, who is 46, has had a long history of kidney failure.
He now manages a plant nursery at our family home, Goodnestone Park in Kent, where the gardens are open to the public. He is married to Laura and they have two children, Cecilia, nine, and Rupert, seven.
A serious accident when he was 13 resulted in years of ill-health that led to him contracting the autoimmune disease lupus in 1987.
But a few months later he suffered total renal failure. Emergency treatment saved his life and he then needed dialysis to keep him alive.
In 1993, the long-awaited breakthrough was offered when he had his first kidney transplant, from a cadaver, as was the norm at that time. But the transplant failed, Francis's body rejected the kidney and, after a period of life-threatening illness, he had no option but to return to the bleak routine of dialysis three times a week.
Just before Christmas 1997, Francis was given a new transplant with another cadaver kidney. This one, however, was a success and he returned home to embark on a more normal life than had been possible for a decade.
But cadaver kidneys have a limited lifespan of little more than ten years, and, in late 2007, doctors told Francis the organ was deteriorating. He had a maximum of two years before it would cease functioning.
Having had two transplants, and with his long history of ill-health and associated medication, Francis was an unusual patient. He had built up powerful antibodies in his blood that would fight against any new kidney he might be given in a transplant, unless it was very well matched.
It was a grim outlook with few options and the worries of his immediate family were heightened by the fact that he now had a wife and children of his own.
And that is where I came in. We are a family of five brothers, Francis the youngest, me the middle one.
Largely for reasons of practicality (such as our brother Henry living in Australia), I was the one who first decided to be tested as a potential donor.
Making the decision to proceed was easy. I knew I could possibly offer Francis the best chance of improved health and long life and I was conscious of the privations he had suffered since his youth.
He had had extensive surgery, years of missed school, day after day in hospital, never being able to develop a career, and the constant burden of feeling unwell.
Nonetheless, as a donor you are voluntarily putting yourself on the line and introducing great turmoil into your life.
Francis Plumptre on George's shoulders in 1965
The brothers: Francis Plumptre on George's shoulders in 1965
My family, in particular my three children, were very supportive. The youngest, Hermione, is about to begin her last year at school and so they were all old enough to be fully aware of Francis's condition and the implications for me.
I had the all-important blood test at Guy's and St Thomas' Hospital in Central London in September 2008. The results would show whether I was a compatible blood group and, crucially, whether I was a good tissue match.
Tissue matching is measured from 1/6 to 6/6 and we knew that anything below 5/6 would cause complications because of Francis's antibodies.
Four weeks later, Isobel Gordon, the living donor co-ordinating sister at Guy's, said that I was a 6/ 6 tissue match - a rare, perfect match.
Looking back from the comfort of full recovery, it is easy to forget the impact of the ordeal you put yourself through. Over months you have to undergo an exhaustive series of tests to confirm you are healthy enough, with sufficiently good, well-balanced kidney function, to be a donor and not jeopardise your chance of a healthy life.
During the tests, my main worry was that some problem would prevent me from being a donor.
In December last year, one test revealed that my kidneys were a different size and that they might work unevenly, preventing me from donating. But further tests confirmed the function was evenly spread so all was well and I was cleared to proceed to the final preoperative stage.
Then, just two days before Christmas, Isobel said a query had been raised by another test and I needed to return in January to see my consultant.
It was a fraught Christmas holiday until I discovered there was an issue with my blood-clotting that needed further analysis. I was sent to see a professor of haematology, meaning a delay to the operation (if I was cleared to proceed) of at least a month.
Finally, on February 14, I was given the all-clear and a confirmed date of March 20 for the operation.
During the period of delay, Francis's kidney function had deteriorated unexpectedly fast and he had been forced to start dialysis again.
Francis was naturally very apprehensive on my behalf and now he had the added disappointment that we had failed to get to the operation without him needing dialysis - the urgency of which was confirmed by his tell-tale signs of ill-health.
I was relieved that we could at last proceed after the months of suspense. But there were days when I felt I was walking out on to a very high diving board.
On the operation day, I was told by my surgeon, Mr Hadjianastassiou, they had found that I had a hernia, which he would deal with at the same time as removing my kidney, with the whole operation to be performed laparoscopically (key-hole surgery).
Perhaps because of the impact of the hernia as well, when I first came round from the anaesthetic I was in considerable pain, which was a real shock. I felt as though I had voluntarily walked in front of a bus.
MRI scan of a kidney
Vital organ: An MRI scan of a kidney
But after six days I was discharged to recuperate at home and was amazed at the rate of my recovery.
Evidence of the surgery was minimal; a 4in scar across my stomach, through which the kidney had been removed, and two tiny scars on my side through which the keyhole surgery was performed.
Perhaps most noticeable was that I had lost about 11lb during the operation, probably due to my lack of activity, which had wasted my muscles.
For Francis, the fact that the kidney started working straight away had the immediate effect of making him feel better, even while he was recovering from the operation. It was amazing to watch and I do not think any of us had been prepared for the transformation of his life.
To ensure that the kidney is properly 'bedded in' and any signs of rejection are overcome, he has been closely monitored by Guy's, but, nearly four months after the operation, the signs are positive.
'I feel better than I have done since before I contracted lupus more than 20 years ago,' he says with barely concealed delight. 'The effect of this kidney is far better than the first cadaver and I feel fitter, more active and have put on some weight.'
The first living-donor transplant was carried out between identical twins in 1954 and was successful. But a lack of effective immuno-suppression drugs (which prevent rejection of the transplanted kidney) meant that the few times the operation was tried again, most ended in failure.
Not until the introduction in 1983 of the first reliable immuno-suppression drug, called Cyclosporin, were improved rates of success possible, and since then refinement of these drugs has been the key to successful living-donor transplants. Legislatively, the leap forward came with the 2004 Human Tissue Act which lifted the previously tight restrictions.
John Taylor, the surgeon who had performed Francis's first successful transplant at Guy's in 1997 and then carried out his recent one in March, said that when Francis had his first transplant at Guy's 'a living kidney transplant was something we did once a month and was a big event'.
Now they have the capacity to do four a week. In 2008, Guy's achieved a landmark when, for the first time, the renal unit performed more than half of a total of nearly 200 kidney transplants with living donors.
For the recipient the benefits are far faster and longer-lasting than with a cadaver kidney. A living-donor kidney can last at least 20 years.
In the UK there are about 30,000 patients on dialysis, but only 2,000 kidney transplant operations are performed each year.
The 2004 Act also made it possible for someone to donate a kidney into a pool and never know who will be the recipient. Every living donor is subjected to an evaluation to establish that they are fully aware of all implications and are emotionally prepared, and that they are not being offered any kind of inducement.
Living donorship has become the future of kidney transplants, while growing kidneys from stem cells is, for the time being, too futuristic.
In a few years, medical advances have brought about a multi-faceted revolution - a change in legislation; better conditions and results for transplant recipients; and a cultural change in renal units such as the one at Guy's because the possibility of living donorship is now routinely discussed at an early stage with patients suffering from kidney failure.
The select group who opt to become living donors - a small, happy club that I have now joined - go through self-inflicted pain before finally discovering an intense feeling of altruistic achievement and an enriching reward that few people are privileged to experience and which, I am sure, lasts a lifetime.
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www.uktransplant.org.ukWhy kidneys play such a crucial role
* The kidneys are located in the lower part of the back on either side of the spine, behind the abdomen. Their function is to maintain the usual concentrations of the main constituents of blood, passing the waste matter into the urine.
* There are 7,877 patients on the national organ waiting list - of these around 6,960 need a kidney transplant.
* Last year there were 3,513 organ transplants. Of these, 2,536 received a kidney, pancreas or combined transplant.
* Living-donor kidney transplants are increasing. There were 927 in 2008/09 - more than one in three kidney transplants.
* Living donors can also give part of their liver or lung. However, risk of complications is higher than with kidney donation.
* The process of donation is started with a visit to the GP or hospital consultant treating the recipient. To become an altruistic donor, your GP will refer you to a kidney-transplant centre for assessment.
* Donors are at risk of infections, bleeding and blood clots, but the death risk is low at one in 3,000.
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