As organ donor awareness week begins, David Labanyi reports on the need for more transplants, more donors and more dialysis machines
'What an awful lot of people just do not understand about kidney failure is that the patient just does not pee. There is no way of getting the fluid out."
This, according to Mark Murphy, chief executive of the Irish Kidney Association, is the daily reality of renal failure. For the estimated 1,200 people with acute renal failure the removal of waste fluids requires hours on dialysis.
It is a gruelling regime and is getting harder because the numbers requiring dialysis are rising fast, leading to an overcrowding of services.
Last year 167 additional patients started receiving dialysis, a 16 per cent jump, far beyond Department of Health estimates.
A rise in dialysis patients is contributing to a longer wait for kidney transplants, with the result that more people are spending longer on dialysis than five years ago.
Mr Murphy describes Ireland's dialysis service as the worst in Europe. "Our dialysis services are awful. The Department compares our service to that in Britain and compared to them we're not too bad ... but they are the second worst and way behind the rest of Europe."
The problem, he says, is two-fold: a lack of donor kidneys and a shortage of dialysis machines.
"There are about 140 adult dialysis stations in 15 centres for 987 patients. If a station works 14-hours-a-day, six-days-a-week, it can dialyse six patients. However, Cork, Beaumont, Galway, Limerick, the Mater, Tallaght and Waterford are all working over six patients per station so they must be working outside that time frame. I call night-time dialysis inhumane dialysis.
"In Germany there are two machines for every five patients, in Holland, two machines for every seven patients."
Although the Department of Health has invested significantly in renal services, including €8 million this year alone, services are struggling to keep pace with demand.
"We have had a lot of investment in renal services but all that will just about absorb last year's rise," he said. "If this trend continues we'll have another 150 patients requiring dialysis at the end of the year."
Mr Murphy says no one reason is behind the rise. "It's a combination of things. A growth in diabetes is the single largest cause but there has also been a rise in the number of nephrologists over the last four to five years. They are diagnosing people who would have previously suffered or died from the condition without being diagnosed."
Dialysis is not seen as a long-term solution because it is expensive and because dialysis cannot perform all the functions of the kidney with the result that there is a 10 to 15 per cent mortality.
"A transplant more than doubles their life expectancy and enhances their quality of life to an immeasurable level. Transplantation is not a cure but it is by far the most preferred treatment," says Mr Murphy.
However, the number of donor kidneys can no longer keep pace with those in need and the waiting list is growing.
Dr David Hickey, transplant surgeon at Beaumont Hospital says Ireland needs to perform a higher number of transplants to cope with the rising demand. "Up to five years ago we were essentially meeting our needs. We had about 150 on the waiting list and we were transplanting about 150 a year.
"Today we have 380 waiting and we are still doing 150 a year. And ... the waiting list is going to increase."
According to Mr Murphy the response to a shortage of donor organs is two-fold. "We are asking the public to make an informed choice to carry an organ donor card and discuss the topic of organ donation with their family in the event of their untimely death."
The second initiative is to start a living-related transplant programme, where a donor kidney would be donated from a relative or spouse. Despite being a key component of renal services internationally, only a handful of these operations are carried out here, usually on compassionate grounds for patients who cannot continue dialysis.
Representatives from Beaumont will shortly meet with the Health Services Executive to discuss setting up such a programme.
Dr Hickey says: "We need to follow the rest of the developed world and start a living donor programme. At the moment up to 50 per cent of the transplants in the US and in Scandinavia are living donor transplants.
"Over a five-year period you are saving about €500,000 per patient. "
On dialysis that is virtually impossible. So there is this double economic incentive for people to develop transplantation as a significant way of looking after renal failure patients."
• Organ Donor Awareness Week runs from April 2nd to 9th.
• IKA volunteers are selling Forget Me Not Flowers and key rings this week.
• Donor cards can be obtained from pharmacies, medical centres, and the IKA on Lo Call: 1890 456 556.