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Dr Dominick Natin, an occupational medicine consultant in Dublin, speaks to Catherine Reilly about his decision to donate his kidney to a person unknown to him
In late 2018, Dr Dominick Natin, a consultant in occupational medicine in Dublin, travelled to Belfast to donate a kidney to a recipient unknown to him.
Dr Natin participated in non-directed altruistic living kidney donation, a process not allowed in this State due to the absence of legislation (however directed altruistic kidney donation, which involves donors who are relatives or close friends, is undertaken). It was an issue again highlighted by the Irish Kidney Association during the recent Organ Donor Awareness Week.
After his experience came to the attention of the Medical Independent (MI), Dr Natin agreed to speak to this newspaper to encourage organ donation. His story highlights how the long delay in implementing human tissue legislation, which the Government contends is necessary to provide for non-directed altruistic donation, has resulted in lost donation opportunities in this jurisdiction. It is a particular irony that Dr Natin works at the Mater Misericordiae University Hospital, which is home to the national heart and lung transplant programme, and he lives near Beaumont Hospital, where the national kidney transplant programme is based.
Consultant Nephrologist at Beaumont Hospital Dr Colm Magee said each year, several people express an interest in non-directed altruistic donation and they are referred to UK centres.
Dr Magee said it was difficult to predict how many extra transplants a year would take place when legal provisions came to play — possibly another three-to-five and more if the donors agreed to some form of kidney sharing, as is now common practice in the UK. A Department of Health spokesperson said the area requires “a robust legislative framework” and the General Scheme of the Human Tissue Bill will be presented to Government “shortly”. The UK’s equivalent law dates to 2004.
Speaking to MI, Dr Natin explained that “from an early age” he wanted to help others. “I was very fortunate that when I was growing up, I had a lovely GP. No matter how unwell anybody in my family were, they always seemed to feel better after seeing him. So I said, ‘well, that looks like a nice job’.” As well as entering medicine, Dr Natin became a regular donor of blood and platelets, and he joined the Irish Unrelated Bone Marrow Registry.
After reading an article by Dr Magee, which highlighted the need for more kidney donations, Dr Natin thought about how he could assist. He wrote to Dr Magee including details of his blood group and HLA typing (which was undertaken when he joined the bone marrow registry). However, he was advised that a donation could not proceed at Beaumont in the absence of the long-awaited legal provisions. The national kidney transplant programme has close ties with UK hospitals and patients from the Republic have participated in paired kidney exchange in the UK. It was suggested to Dr Natin he could consider donating at one of these centres. He decided he would like to donate in Belfast City Hospital, where it transpired there was a well-matched person on the waiting list.
Dr Natin said he did not feel trepidation about entering this process, which he ascribes to his background in occupational medicine, with its strong focus on risk assessment.
He spoke to family beforehand and later prepared letters for them and the medical team in the unlikely event that something went drastically wrong.
“I read widely about it. I drew my own conclusion that in the right hands — people with a lot of experience — it is a relatively very safe operation. It turned out I was in excellent hands. Dr Magee referred me to Dr Aisling Courtney, a consultant nephrologist in Belfast; she was absolutely fantastic, and my surgeon was Mr Tim Brown, who is an excellent surgeon.” The renal unit in Belfast was “top class”, he added.
The assessment was very thorough, according to Dr Natin. He travelled to Belfast on a Tuesday night, stayed at a guesthouse, and began the process early the following morning. “I was finished about 4.30pm on the Thursday and came back down.” The process included a legal assessor to “establish that I was of sound mind to give my kidney away. Overall, it was a very pleasant experience and very efficient”.
Subsequently, on a day late last year, he worked until 6pm and got the train to Belfast. He stayed overnight in hospital and the operation took place the following day. “I woke up that evening feeling absolutely fine… I was told the good news, that the recipient had got the kidney, it was working well and the medical teams were very happy.” Less than 24 hours after the operation, Dr Natin was informed he was fit for discharge. However, he stayed an extra day, as his wife preferred that he err on the side of caution. While not the usual practice, he was told the recipient wished to meet him before he left the hospital. This person was “very lovely and gracious” and has since written to him describing how their life has “changed completely”.
“Then I stayed in Belfast for a few days to make sure I wasn’t having any postoperative complications.”
It is advised that donors take at least four-to-12 weeks’ leave, and Dr Natin returned to work within four weeks of the procedure. Dr Natin, who works across three hospitals, had to arrange locum cover, which was difficult. In addition, while he had access to vouched expenses under the NHS system, he preferred not to avail of this. He was delighted to have helped the organ recipient in Belfast, although would have donated at Beaumont had this been possible. “It would have been next door to my family and friends, and they could have visited me. Unfortunately, the Government doesn’t allow it.”
MI asked Dr Natin about the reactions of colleagues. “My immediate nursing and administrative colleagues were very supportive. Some medical colleagues thought I was absolutely mad to do it”, owing to either the time-out required or the level of perceived risk. And then there were other medical colleagues who “just had a complete indifference”. He feels this might be suggestive of why Ireland’s deceased and living donation rates are average.
“There are certainly a lot of people, including colleagues, who need to be educated about the fact it is a relatively safe operation,” he added.
People interested in donating should consider having an assessment, he said. “Because you might not only be able to directly save a life, but indirectly save many lives through the kidney donation chain.” It is a privilege to be able to donate, he emphasised.