The Royal Gazette takes a look at organ and tissue donation in honour of the April Organ and Tissue Donor Awareness Month. Tomorrow we will feature an American couple who made the heart-wrenching decision to donate their daughter’s organs after she was murdered in a train shooting, and we will also talk to a Bermudian who was lucky enough to receive a new kidney at the age of 14.

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You may have seen the bumper sticker with the message ‘Don’t take your organs to heaven; heaven knows we need them here’.

It belongs to Marianne Herbert, a dialysis nurse and renal transplant co-ordinator at King Edward VII Memorial Hospital. Since the first Bermudian received a transplanted kidney in the 1970s she has helped over 83 Bermudians through the kidney transplant process.

“When you’re waiting for a kidney transplant, you have to be ready to leave the Island at a moment’s notice,” said Ms Herbert during a recent interview with the Royal Gazette.

“Sometimes, you have just an hour.”

In one case, Ms Herbert had to track down a man waiting for a new kidney, haul him out of a taxi, rush him to the airport, out a back door and onto a waiting airline flight.

“There wasn’t time for him to go home,” said Ms Herbert.

“His wife was on the beach with the two children. Fortunately, he had American cash on him, his driver’s license, credit card, and medical insurance card. By the time the wife reached him the next day he had a working transplant.”

People on the list for a new kidney often have to be airvacced off the island, but sometimes getting the special plane here can be difficult.

“One patient last year went out on an executive jet, because we couldn’t get an airvac, so it is so important that they are ready to go,” said Ms Herbert.

Patients are urged to either keep a case packed, or keep a list of what they want to take, because when the call comes through it is very difficult to concentrate on practical things.

Most Bermudians receive kidney transplants through Brigham & Womens Hospital in Boston, Massachusetts.

“Bermudians are absolutely on par with Americans on the potential recipient list at Brigham,” said Ms. Herbert. “King Edward VII has a reciprocal arrangement with the New England Organ Bank. They donate to the New England Organ Bank, and in return they transplant Bermuda patients.”

There are many people in Bermuda who have been on kidney dialysis for twenty years or more. Kidney transplants aren’t for everyone.

“It is major surgery,” said Ms Herbert. “There are certain medical conditions unrelated to their kidney disease that would exclude some people on dialysis from being candidates because the medications that they would receive afterwards would make those diseases worse.”

There are currently around 90 patients on dialysis at the hospital, and only a quarter of these are transplant candidates.

“A transplant is not a cure,” said Ms Herbert. “A lot of people think they will get a transplant and they will be cured.

“It is a treatment option, and people will have to take medications for the rest of their life to prevent the kidney from rejecting. They will have to possibly deal with complications from those medications. They will also have to take good care of themselves.”

Once potential candidates for kidney transplants are identified, Ms Herbert sees them, educates them and arranges for them to go abroad to be evaluated.

At Brigham & Women, they will meet the kidney transplant team which consists of a transplant surgeon, a transplant nephrologist who is a specialist with kidneys, a transplant nurse co-ordinator, and a transplant medical social worker. Potential kidney recipients also often go through a type of cardiac testing that is not available in Bermuda.

“Once they have been seen and cleared for transplant, when they get back to Bermuda, I follow them very closely to make sure that they do stay in good shape, ready for a transplant,” said Ms Herbert.

They also have to have a blood sample sent every month to the tissue typing lab in Boston, so the info on their tissue is always current in the United Network of Organ Sharing computer system. This computer system helps to match blood and tissue of donors and recipients.

“If there is a perfect tissue match then it doesn’t matter if you have been waiting for a kidney for a week or ten years,” said Ms Herbert.

“Probably once every three years we do get a perfect tissue match. You also have to be blood type compatible.”

However, she said experts at Johns Hopkins Hospital in Baltimore, Maryland are making strides in crossing the blood type barrier.

“There are all sorts of exciting programmes happening which will increase people’s chances of getting kidneys,” she said.

Once on the waiting list, the wait time mostly depends on the person’s blood type. People with O and B blood types wait an average of five years. Those with type A wait three years, and ABs usually receive a transplant within a year.

The number of locals receiving kidney transplants varies every year, but 2006 was a record year with eight kidney transplants performed on locals.

“Six of them were from cadaver donors and two were from living donors,” she said. “Brigham also had a record year for transplants.”

With living donors, it is often a relative who decides to sacrifice a kidney to save a loved one. Last year, a twin donated a kidney.

“In another situation, there was a mother wanting to give a kidney to her adopted son at Brigham, but they were an incompatible blood type,” Ms Herbert said.

“She also had a rare blood group that our potential recipient in Bermuda had. There were only two people of that type waiting for kidneys on the Brigham list. They elected to let that mother donate to our potential recipient, and in exchange her son, who was a common blood group, was moved to the top of the waiting list. He got a kidney a couple of weeks later. He was very lucky. That is the first time I have known that to happen, with our patients anyway.”

She said there is an emotional component to receiving a kidney from someone who has passed away. On one hand, you are happy to receive a kidney, but on the other hand, you are sad for the family who has lost a loved one.

“By accepting that kidney, I do believe that you are giving a degree of comfort to the family who has donated the organs,” said Ms Herbert.

“It is some comfort for the family to know that part of their deceased loved one is living on in someone else.”

Ms Herbert said the success rate for kidney transplants is very good, and with the introduction of new medications, the success rate gets better all the time. There is one man on the island who has had a transplanted kidney for 34 years, and another lady who has had one for 21 years.

She urged people who would like to be organ donors in the event they become brain-dead after an accident, to discuss it with their families. Families ultimately have to make the decision.

There is an organ donor box that can be ticked off on a Bermuda’s driver’s license, and people can also fill out a form at King Edward VII, that informs the hospital and their family what they would like to happen in the event of an accident or emergency.For more information about organ and tissue donation, go to http://organdonor.gov/

Don’t take your organs with you