150 lives saved and counting

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In Conversation provides a glimpse into the life of a healthcare professional with a passion for their field of medicine. In this issue we talk to Professor Paolo Ferrari who established the Australian Paired Kidney Exchange (AKX) Program in 2009. To date, the program has saved over 150 lives.

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The AKX creates a pooled resource of donor kidneys from living donors that can be matched to compatible patients. What were the factors that lead you to create this program?
There were two simple factors here. Firstly, as a kidney specialist I was aware that if you have kidney failure and you need a kidney transplant, receiving a kidney from a live donor with little or no waiting time is better than waiting for a deceased donor organ and you’ll enjoy longer survival because generally you’ll get a better quality organ.
Secondly, about half of the live donors that are discarded are deemed unsuitable to their loved one because their blood group or tissue type doesn’t match. In the past we would thank these donors for their good intention, let them go and ask the recipient to join the waiting list. Because you can imagine that this happens for many pairs around the country, why not pool those incompatible pairs? I could see the value in a kidney paired exchange that helps ensure transplant recipients get the organ that is the best match for them.

Professor Paolo Ferrari

In what instance would a person opt to sign up for the AKX program?
Any patient with kidney failure, even if they have not yet started dialysis, can sign up to this program if they have a healthy and willing donor who is not compatible with them. There are also healthy people who want to give one of their kidneys to a person in need, but don’t personally know anyone. These altruistic donors are an incredible asset to this program, because they will start a chain of domino transplants that otherwise could not occur, and therefore one donor can help many patients get a life-saving kidney transplant.
What difference have you seen the AKX make in an individual’s life?
I have received many amazing testimonies both from pairs who I had the pleasure to meet and care for and some whom I never met. For donors they feel they have helped two people to get a healthy kidney, their loved one and the one to whom they donated their own kidney and this makes them feel more special. For recipients, a new kidney changes their life and the lives of their loved ones and there is the added benefit with patients in the AKX program of relief from the emotional burden of being told that a loved one is not a compatible donor.
There are recipients who have been on dialysis and the deceased donor waitlist for a decade. Every story is different and it’s an incentive to try and help even more incompatible live donor couples share this wonderful gift of life.
A kidney exchange can involve more than ten synchronised operations across the country. What are some of the challenges e.g., transport of organs, surgical complications, one participant pulling-out?
One donor pulling out at the 11th hour would disadvantage one recipient from another pair within the chain. To eliminate this risk we ensure that the donor surgical procedures occur simultaneously in a chain. The donor and recipient surgeries are carried out at the transplant centre where they have been evaluated and the donor kidneys are then transported to the matched recipients’ transplant centres.
Coordinating multiple simultaneous surgical procedures in different hospitals is a complex undertaking that requires weeks of planning, from finding a date that is suitable for all the hospital personnel involved, supplying the specific container for organ transport, to booking couriers and flights. The challenge is anticipating all the possible problems and having an alternative plan for each single unforeseen situation that might occur.
The key ingredient to success is a dedicated coordinator with unsurpassed organisational skills and a good nature to be able to negotiate with all parties involved for the best possible outcome. I have had the good fortune to work for several years with Claudia Woodroffe, as the national coordinator of the kidney swap program, and while we have had a handful of hair-raising adventures, in the end, it has all worked out every time.
Kidney disease is common in Australia yet the rate of organ donation is low. Where are the perceived barriers and what would help more Australians become organ donors?
The rate of deceased organ donors in Australia is certainly lower than in some other countries but it’s rising steadily. Unfortunately, in Australia only 60 percent of families give consent for organ and tissue donation to proceed. The downside of the success in deceased organ donation is that we are seeing a decline in live donation. This is not the case in other countries that share similarities to Australia.
For example, The Netherlands, with a population of 16.8 million, has seen a 30 percent increase in live kidney donations (from 413 to 534) between 2008 and 2014, while in Australia we have seen a 25 percent decline (from 354 to 267) over the same period. This is a worrying trend and we ought to do something about it.
What inspires and motivates you to continue with your work?
There are many factors that inspire me to continue finding new solutions to old and new problems. At the end of a busy day, to know that I have helped to make a difference in someone’s life is enormously satisfying.
The feedback from colleagues – the doctors, the surgeons the nurses that have worked in synchrony together to make the impossible possible – is equally motivating. Interacting with our junior doctors and trainees as the future innovators of medicine in our country is another important stimulus. And very importantly, my highly supportive and understanding family really helps me to find the inspiration I need to continue with my work.