Good Morning.
Thank you for asking me to attend today. My name is Liam Plant. I work as a Consultant
Renal Physician at Cork University Hospital. Between 2003 and 2009 I acted as Chair of the
National Strategic Review of Renal Services. Since March 2009 I have been the National
Clinical Director of the HSE National Renal Office (NRO). The National Renal Office is
responsible for planning, co-coordinating and managing the strategic framework of Renal
Services across the country. Prior to 2001 I worked as a Consultant Renal Physician at the
Royal Infirmary of Edinburgh.
In common with all countries, the number of our fellow citizens afflicted by permanent
kidney failure (technically described as End-Stage Kidney Disease (ESKD)) continues to grow.
The NRO conducts an Annual Census of this on the 31 st of December each year. On 31/12/12
just under 4,000 of our fellow citizens had ESKD, 81 of these being aged under 18 years. Of
the 3,876 adults with ESKD, 1560 (40%) received treatment by Haemodialysis at a number of
Haemodialysis Units dispersed around the country. 237 (6%) were treated by one of the
forms of Home Dialysis in their own homes. Thankfully, and a testament to the existing
success of the Renal Transplant Programme in Ireland, 2079 (54%) already have a
functioning Kidney Transplant. 62% of children with ESKD currently have a Kidney
Transplant.
Whereas all types of renal replacement therapies are successful treatments for ESKD,
prolonging survival, improving functional status and allowing patients to carry on with their
lives, there is no doubt that Kidney Transplantation is the best of these options. It is the
policy of the NRO that strategic planning should seek to maximize the numbers of patients
who can avail of this. Whereas not all patients may be suitable as recipients of a kidney
transplant, many more than have currently received one are so. This is reflected in the
waiting list for kidney transplantation.
As well as being a considerable physical, social and psychological burden on patients with
ESKD treated by any of the forms of dialysis therapies, the costs to the State of providing
these therapies are very substantial. In 2011, the ESRI noted (Activity in Acute Public
Hospitals Annual Report 2010) that the highest ranked procedure for Day Patients in Public
Hospitals was Haemodialysis, accounting for over one-fifth of all such cases. In 2012 almost
250,000 such procedures were delivered. Irish patients travelling to-and-from their
Haemodialysis Units travelled over 13.5 million km in 2012. Despite reductions in the costs
of such treatments in recent years, the sheer number of procedures continues to generate
very substantial revenue charges.
In the 5 years since 2007, the number of adults with ESKD has increased by 24%, an absolute
increase of 743 patients. Of this increase, 63% has been accounted for by an increase in the
numbers of those with a functioning Kidney Transplant (466), with the remaining increase
due to an increase in those treated by Dialysis (277).
There is, therefore, little doubt but that an increase in access to organs suitable for
transplantation would improve the survival, rehabilitation and quality of life of many more
patients with ESKD than at present. Furthermore, the potential future costs of Dialysis
therapies foregone as a consequence of an increase in the transplantation rate would
benefit the Renal Programme, the Health Service as a whole and the Irish taxpayer.
The principal question that needs to be addressed is: how is this best achieved? A variety of
potential solutions have been advanced by a variety of individuals, organizations and health
care systems. I am happy to offer my own observations on those elements that I think are
likely to increase transplantation, whilst preserving the confidence of the wider citizenry in
the organization of this activity. Undoubtedly, increasing the resources available to support
Living Donor transplantation is a key element. But what of Deceased Donor transplantation?
As has been highlighted in a UK Health Technology Assessment (Health Technology
Assessment 2009; 13:26), a number of elements contribute to the variation in rates of organ
donation between countries. These include:
1. The national wealth and the investment made in Health Care Services.
2. The legislative framework that underpins donation (particularly as this applies to
questions of ‘presumed’ or ‘informed’ consent).
3. The availability of potential donors
4. Public attitudes to, knowledge of, and education about organ donation and
transplantation.
5. The organization and infrastructure provided to deliver organ donation and
transplantation services.
Much commentary has focused on Item 2 and it is of great importance. However, I would
strongly associate myself with the views expressed by others that in the absence of a robust
organization and infrastructure to support this endeavor, any legislative framework is
unlikely to achieve its maximum potential in increasing donation. Similarly, robust
engagement with the public to minimize anxiety, misunderstanding and fear regarding any
potential legislative changes must also be of the highest importance.
Thank you.