Keith

INTERVIEW

Why did you become a transplant surgeon?

When I was a medical student, surgery was the thing that attracted me the most so I trained as a surgeon, although I wasn’t quite sure which area to specialise in. Whilst spending a couple of years doing research somebody was needed to help on the transplant rota, so I got some early experience of transplantation then.
 
The next job that became available as a training post was a transplant job, and because of the experience I had, I was the best person qualified and got the job. I haven’t looked back since really. I think it’s like lots of things, being in the right place at the right time. It may well have been the hand of God leading me into this area and it’s certainly interesting to look back and see how things have turned out.

Tell us about about your experiences as a transplant surgeon

I’ve been involved in organ donation transplantation for about 25 years, so I’ve seen a lot of patients. I specialise more in kidney transplantation, both on adults and children, which unlike many other branches of surgery gives you the opportunity to get to know patients and their families really quite well. Kidney disease is a long-term commitment for patients and their families. A number of patients will say to me ‘Did you know you’ve done 12 or 13 operations on me over the years?’

You develop a relationship with them and, as ever, there are always some patients that stand out more than others. I’ve transplanted a few very young children who always provide more of a challenge but it is amazing then to see them grow up and blossom. Also, for some of the adult patients who have perhaps been waiting for a long time and are well known within the unit, it is very gratifying when an organ becomes available for them and to see the difference that then makes to their lives.
 
There are times when transplants don’t work well, there are no 100% guarantees, and I think it’s always hugely disappointing and sad, not just for the patient and their families, but also for the team who feel it as well.

Is it difficult to see so many on the waiting list?

It’s frustrating and we all know that we could do more. One of the things we do when a patient is on the transplant list is to see them every year just to make sure that they remain suitable. Certainly for some people who have been waiting a long time, you can feel guilty seeing them on such a regular basis because you have little else to offer them. You try and offer some hope but for some people they end up waiting longer for various reasons. Roughly 3 people will die a day whilst they’re waiting for a transplant, and we would love to be able to give to everyone who needs a transplant, but given the shortage of organs, it’s just not possible.

But there is always hope. There was a young chap that we transplanted recently who had been waiting for 15 years for his second transplant. There had been various reasons why he couldn’t have it, but to finally be able to give him a working kidney was a great encouragement.

What is it like to experience such physical generosity?

I see it particularly in the context of living donor transplantations where a family or someone who is close to an individual will give their kidney. They’re willing to go through a major operation to give one of their kidneys to a loved one. It is a tremendous act of generosity. This type of donation is happening more frequently and around a thousand living donor transplants are performed in the UK a year. There are a lot of really generous people out there. Some people go a step further and are willing to donate one of their kidneys to a total stranger. That is a huge decision to make and a huge act of generosity. It’s not something that most of us would choose to do, but there are people out there who are very generous and giving in all aspects of their lives.
 
But there are also around 1000 deceased donors per year in the UK where an individual in life has made a decision to be a donor, or where their family has made that decision on behalf of their loved one after death. This is often a difficult decision at a very difficult time, but it can help up to nine individuals who are in need of a transplant – it is indeed a generous gift.

How do you find the experience of meeting organ recipients and their families?

In one sense you do have to try and remain professional and emotionally detached. I think if you get too emotionally attached it can affect the way in which you do things. I would hope that I have a similar approach to everyone, irrespective, but it’s inevitable that there are some patients that you do get to know better. But once you get into the operating theatre then you treat everyone as an equal.

What is it like to tell people an organ is available?

It’s really great. You’re aware that people have been waiting, often a long time, when you contact them. For a deceased organ donor transplant you tell them an organ is available in a phonecall, usually in the middle of the night, and they come in with a rollercoaster of emotions not quite sure what to expect.
 
Walking through the clinic area afterwards you get to see the difference it makes to people’s lives. They haven’t got the restrictions that dialysis brings and hopefully now have more free time for their families, to go back to work or really just to try and fulfil the potential they have again.

Should we talk about organ donation more with family and friends?

People generally don’t like talking about death when they’re alive. I suppose it’s a bit like writing your will, but if you write a will it makes it easier for your family at the point of death to know what should happen with all your belongings, and actually, it really should be the same with your organs. If they are going to be of particular use, it’s far better that your family know about your wishes as it helps them to make those decisions at that difficult time. At the point of death it really can be a dreadful experience for anyone to begin to consider the wishes of their loved one and often your mind doesn’t work as clearly as it would at other times. If you know those things in advance, it must make such a difference.

How has your faith impacted your view of blood and organ donation?

Certainly, from a Christian faith point of view, there are some very positive aspects around the idea of blood and organ donation. Of course, there’s nothing in the Bible specifically and there isn’t an eleventh commandment that says ‘you shall donate your blood and organs’, but I think there are a number of themes in the Bible that fit with blood and organ donation. Loving others, showing respect, and being generous are things that we’re all encouraged to do.

As a Christian, blood and organ donation is something that I think should be encouraged. There are some who wouldn’t accept an organ on the grounds that it’s simply God’s way of saying it’s their time, but for most that isn’t the case. As Christians, we want to be loving and generous individuals, and blood and organ donation is an ideal opportunity to show that. In the Bible we’re told that we will be given new bodies when we die so it’s not as though we need everything. If we’re given new bodies, it seems reasonable to me to be willing to donate what we have to help others while we can, either in life or in death.

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Keith Rigg is Consultant General and a transplant surgeon at Nottingham University Hospital's NHS Trust. He is Past President of the British Transplantation Society and Chair of Transplant 2013,