As Health New Zealand’s renal transplant service at Auckland City Hospital, and Organ Donation NZ, celebrate the 3000th kidney transplant performed in Auckland earlier this year, many more could benefit from life-saving surgery, if there were more donors.
Kidney failure is a significant health problem in New Zealand, and while dialysis is one available treatment option, an organ transplant provides a better lifestyle and longevity for patients who are well enough.
Three times kidney transplant recipient, John Kearns of Ngāti Kuri/Te Rarawa whakapapa, knows first-hand the significant, positive effects a new kidney can provide. He was only 20 years old in 1984 when he discovered that his kidney health had already begun to deteriorate, and he had only 20% kidney function – after six months of dialysis he received his first kidney transplant from his sister in 1987.
When this began to fail, and after more dialysis, he received his second and third transplants from deceased kidney donors; on Father’s Day in 2002 and Christmas Day in 2015. The significance of these days isn’t lost on him, with three grown daughters and three grandchildren.
“These transplants allowed me to have children, and now mokopuna,” he says. “They’ve let me to continue to work. They’ve made a huge impact on my life.”
While dialysis meant he had to stop going to sea for his maritime career, he’s stayed within the industry by working as a ship broker for the past 13 years. He’s now 60 years old and enjoying life with his family.
“I’m very thankful to have these transplants and the longevity they’ve given me on this journey,” he says.
Kidney failure and transplants
Drs Jafar Ahmed and Carl Muthu lead the renal transplant service at Auckland City Hospital, which is the largest kidney transplant centre in New Zealand*.
“In 2022, an estimated 5,500 Kiwi patients received kidney replacement therapy – over 2,500 were living with a functioning kidney transplant, or transplants, and another 3,000 on dialysis,” says Dr Ahmed.
“Dialysis requires patients to have their blood filtered for several hours, typically three times a week, or do daily dialysis at home. It can have a considerable impact on their lifestyle and can result in health complications,” Dr Ahmed continues. “For those who are well enough, transplantation can offer the greatest potential to them to return to a healthy, quality life.”
There are currently 600 New Zealanders on the kidney transplant waitlist. Of these, 400 are actively waiting, or well enough to have a transplant. However, if there were more donor organs available, then more transplants could be performed.
The outlook for patients with a first kidney transplant is very positive – after five years the survival rate is 85%. On average half of all deceased donor transplants extend their lives by 14-15 years, while half of all live donor transplants extend it by 20 years.
The renal team at Auckland District Health Board (as it was known then) performed its first transplant in 1965 and averaged 10-15 live and deceased kidney donor transplants a year for adults under 50. Since then, the clinical team has doubled in size – to six physicians, four surgeons, plus six coordinators instead of one clerk – and, alongside medical advances, accommodate a wider group of transplant patients.
“Over the last five years in Auckland, we’ve performed 660 transplants on both adults and children,” says Dr Muthu. “Of these 238 were from live donors, who are generally found through the patient’s local hospital, and 422 from deceased donors we receive through Organ Donation NZ.
“These numbers include transplants performed during COVID-19. We were one of few worldwide renal transplant services to continue throughout the pandemic.”
More donor organs needed
Traditionally, New Zealand’s deceased donor rate has been much lower than ‘equivalent’ countries such as Australia or USA,” says Dr Ahmed. “While the rate has improved over the last few years, it is still behind**.
“Reaching the 3000th milestone is a great achievement, but we have the capacity to perform so many more transplants if there were more donor organs available. This would not only benefit recipients, but also reduce the number of patients on dialysis, as well as the significant cost involved in dialysis.”
For deceased donor kidneys, Auckland City Hospital partners with Organ Donation NZ (ODNZ), which provides a 24-hour, 7-days a week, clinical service for deceased organ and tissue donation to health professionals in hospitals throughout New Zealand.
ODNZ Donor Coordinator Team Leader, Sue Garland, says organ donation is a precious gift that has a profound impact on both the deceased donors loved ones and the recipient.
“We’d like to extend our heartfelt gratitude to all organ donors, and particularly to their families for saying “yes” – you have given so many people a second chance at life. “
“Organ donation is only possible through a donor family making this generous decision at a difficult and sad time. Their choice to donate organs and tissue saves and changes lives.”
In fact, one donor has the potential to help up to 10 people through the donation of organs and tissue, she says.
“For those who are considering being a donor, it’s important that you express your wishes to your whānau and have that important conversation now.”
Dr Muthu agrees: “Without donors the renal transplant unit and ODNZ wouldn’t have been able to make a positive difference to the lives of the thousands of patients, as well as their whānau. It’s truly a wonderful gift, and we’re proud to be part of reaching this significant milestone.”
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Contact: hnzmedia@tewhatuora.govt.nz