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Donating a kidney to give a colleague a chance of life: by becoming a live kidney donor, one nurse has helped raise awareness among her colleagues that genetically unrelated people can also donate their kidneys to others.

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Two nursing colleagues from Christchurch Hospital's cardiac ward are now inseparably linked, following a kidney transplant operation in January.

Kidney donor Claire Johnston has worked alongside Lynsey Farra for the last nine years. Over that time, she has watched her friend's health deteriorate into end-stage renal failure and was eventually confronted with the question: "What am I prepared to do to help someone else have a chance of life?" It became clear to her that if Lynsey could not find a suitable donor, she either faced death or being hooked up to a dialysis machine for the rest of her tile. "The more I thought about it, the more I decided I could do this for my friend. I am fit and healthy, single and with no children, so why shouldn't I offer my kidney? My Christian faith also challenged me to ask what I was wilting to do for another human being."

Farra's kidneys were damaged over 20 years ago when she had an allergic reaction to some antibiotics after fatting ill overseas. She was also the first New Zealand recipient of a cochlea implant, having lost her hearing in the same medical misadventure in Greece. "Lynsey had been through enough and I felt she really deserved another chance. I didn't want my friend to die and I also knew she would do everything she could to protect that kidney after the transplant operation. A new kidney requires lifetime management and care, so any recipient must be prepared to do this. The doctors recommended that Lynsey have the transplant before getting bad enough to have to go on dialysis, as that would give her a better outcome."

When Johnston invited her friend to coffee a year ago and offered to undergo tests to see whether she could be her kidney donor, Farra was "stunned" However, Farra doubted they would be a match and was wary of putting any pressure on her friend. Her two siblings had been unable to be her donors because of pre-existing medical conditions. Johnston and Farra then went through months of preparation, including meetings with the transplant coordinator at Christchurch Hospital, Sarah Armstrong, and medical adviser John Morton. Morton headed the kidney transplant programme in Christchurch from 1973-1996 and, though now retired from surgery, continues to counsel potential living kidney donors. Deciding to donate a kidney is complex, with a range of physical and emotional issues to consider.

"The first thing I had to do was decrease my body mass index. Over the next few months, with the help of the hospital dietitian and a gym programme, I lost 11kgs. In April, we had our blood tests done to see if we were compatible. After several weeks, we were told we were a match. I then had a CT scan to check the blood supply to my kidneys. The surgeons decided to take my left kidney as that was an easier option, and to do the operation laproscopically if at all possible. Recovery from laproscopic surgery is much easier and quicker than from open nephrectomy. You have more scars, but they are smaller."

Support from nursing colleagues

Johnston and Farra were told of their surgery date only three weeks before the operations were to take place. Each had their own surgeon working in different theatres. They were given adjoining rooms after the surgery, though Farra was kept in isolation. Johnston was very touched by the support they received from their nursing colleagues. "They decorated our rooms and sent masses of cards, flowers and baking. Having that support has been really important for us both."

Johnston is now recovering at home and is grateful for the six weeks' discretionary sick leave she has been given. She is keen to keep her weight down to reduce any chance of developing diabetes in the future. Otherwise, she expects her lifestyle to continue as normal, with an annual check-up to ensure her remaining kidney continues to function well.

"For Lynsey, the recovery period is much more challenging, especially during the first three months. She must take care with her diet, avoiding any risks of food poisoning or contracting infections, as those who have had a transplant have a lowered resistance to illness and infection. She goes to a hospital clinic every day for blood tests, has to weigh herself every morning, take her blood pressure and temperature. She also has to measure all her urine to make sure her kidneys are functioning. Her urine output was very little when they were not working; now she's got to get up in the night to pee. She also has a number of tablets to juggle, including immunosuppressive tablets which she will be on for life, antibiotics and anti-viral tablets."

Farra is also pleased with her recovery so far, but is taking everything one step at a time, staying quietly at home when she is not at the hospital and enjoying her increasing sense of wellness. She will have a minimum of two months off work. "This is quite an emotional time for me, especially when I see the line of people at the hospital going up for their dialysis treatment. I was so very lucky not to have reached that stage. We were also very lucky there were no surgical complications--I have nothing but praise for our nephrology team."

The prospect of her body rejecting the new organ is still a reality for Farra, however, and this does make her nervous at times. "But each day I feel that little bit better and having normal blood results seems a miracle. Being able to eat a more varied and normal diet these clays than I could over the months before the operation, when my kidneys were failing, is also wonderful. Claire has given me a second chance of life. She is a very special person. How can I ever thank her?"

Johnston has been comforted by the prayers of her church family at Spreydon Baptist Church. With such support, she felt sure the operations and long-term prognosis would be successful.

Transplant need increasing

According to Sarah Armstrong, one of the few non-nurse renal transplant co-ordinators in the country, the success rate for kidney transplants in New Zealand is very good, with more than 95 percent working at one year and 78 percent at five years. Some people are fortunate to have kidney transplants for over 30 years. Last year, there were 58 live donor and 65 deceased donor kidney transplants carried out in New Zealand. However, as diabetes rates continue to climb, the need for kidney transplants is increasing. Although the closeness of tissue matching affects the chances of rejection, living donor kidney transplants, even from unrelated people, do better than deceased donor transplants.

"Kidney transplantation is considerably cheaper than keeping a patient on dialysis for the rest of their lives," said Armstrong. "It also affords a superior quality of life, so increasing the donor rate is seen as a priority. There are currently around 2000 people in New Zealand receiving dialysis treatment, with about 17 percent of them on the transplant waiting list. Only three percent of that 17 percent have had a previous transplant."

Figures from the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry 2007 report show that of those on the transplant waiting list, 22 percent were Maori, 14 percent were Pacific Islander and six percent Asian. In 2006, the percentage of live donors increased from 49 percent to 54 percent of all transplant operations, with the numbers of genetically unrelated donors increasing from 14 in 2005 to 21 in 2006. Unrelated donors represented 43 percent of all live donors in 2006. (1) Some of these are non-directed donation and the recipient does not know the donor. The average wait for a deceased donor kidney is three to five years, depending on the patient's blood group. (2)

Johnston is hoping her story will inspire other people to consider donating a kidney to someone in need. "Many people don't realise you don't have to be a relative to donate. It has been good to see our colleagues at work starting to talk about the subject and to wonder what circumstances would inspire them to donate a kidney. Some say they could do it for their own child and others are thinking a little wider than that. It is great to see awareness being raised. More people are now having to go on dialysis because of kidney disease and complications from diabetes, with rates predicted to increase by four to six percent annually. There is a real need for more donors in this country."

NZNO involvement

As well as being a very committed nurse and friend, Johnston is also a very committed NZNO delegate, with 15 years in the role, the last five of them as co-convener at Christchurch Hospital She has been a member of the last two multiemployer collective agreement national negotiating teams. Being on the negotiating team and working as a delegate has given her a new focus and added to her skills, she said. "The skills I have developed in these roles have been a bonus to me in my nursing, giving me an awareness of the bigger picture and its impact on nurses' lives. It frustrates me that so many nurses are apathetic when it comes to involvement in NZNO. They want the pay increases but don't want to do any work to achieve them. I now work nine days a fortnight, which gives me a day a fortnight to catch up with other things in my life."

Johnston's greatest hope is that Farra's new kidney will continue to work well and her friend will regain her quality of life which had gradually disappeared over the past year. "I want to see Lynsey being able to do the things she Loves again, like tramping and cycling. Seeing her do these things again will be all the thanks I need."

References

(1) The Australian and New Zealand Dialysis and Transplant Registry. The 30th annual report, www.anzdata.org.nz. Retrieved 19/2/08.

(2) New Zealand Kidney Foundation. www.kidneys.co.nz. Retrieved 19/2/08.

By co-editor Anne Manchester
COPYRIGHT 2008 New Zealand Nurses' Organisation
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2008 Gale, Cengage Learning. All rights reserved.

Article Details
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Title Annotation:PROFILE
Author:Manchester, Anne
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Mar 1, 2008
Words:1697
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