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So then, stepping to the next section, how did you find out that an organ was available
for you?
Yeah, so it was a Sunday afternoon and I received a phone call from the lung transplant coordinator
at the Alfred Hospital to say that they had some donor lungs that were potentially suitable
for me, but they wouldn't be able to know for sure until they'd had a chance to examine
the lungs and to do some tests to make sure that that was a good match.
In the meantime though, I still had to make my way over to Melbourne because there's
a limited sort of time to get over there for the surgery.
So going over there, knowing that potentially the transplant might not go ahead.
When we arrived in Melbourne, it was about midnight and we went straight to the hospital
and there had a final physical exam and blood tests and things were taken and was prepared
for surgery and they told me at that point that it would be going ahead.
So how long did that whole process take from when you were told to when you were ready?
I got the phone call at about four o'clock in the afternoon and we arrived in Melbourne
at midnight and it was probably early hours of the night that I had the actual surgery.
So quite a long wait.
So Toby, we went over a little bit about the decisions made as to where the organs go
and who gets them etc.
So how would SAMs have come about in terms of the matching I guess or even Rhonda might
want to chip in here as well in terms of her pathology, I guess.
Well how it works is kidneys are advocated and lungs and much on the degree of tissue
matches as Rhonda was saying but also on waiting time.
So I'm best familiar with kidneys and islets so talk from that point of view and about
80% of the kidneys that we transplant will be allocated based on the length of time that
somebody has been waiting on dialysis and about 20% of the kidneys that we transplant
as Rhonda was saying before are allocated on matching.
So if we get a terrific match for somebody from Queensland let's say we will ship an
organ from South Australia or from Western Australia to that particular person because
we know that those two organs because those HLA molecules that Rhonda showed you before
match so closely they are more, they are less likely to get rejection and that organ should
do better in the long run.
So that's the HLA side of things.
The other angle of it is the waiting time and I mentioned before that we can also prioritise
people and I'm expecting someone will ask me about children so I'll get you off a pass
by saying that we have a system that enables us to prioritise children to get transplants
under a variety of circumstances but no, for example with the kidney no child will wait
on dialysis longer than 12 months and if they get to 12 months then immediately they go
to the top of the list and they will get the next available organ that's cross-match
negative nationally.
So we do try very hard to get children off dialysis and I would have to say that most
children will end up getting a transplant from a relative and often never even make
it need to wait for a deceased organ donor.
But the matching process is a complicated business and that's Rhonda knows so well.
The national organ allocation system is sent usually in the middle of the night, I can
tell you that, it's usually about two o'clock in the morning and it's usually about 60 pages
long when it comes through to you on a PDF so usually up for about two hours scrolling
through these sheets and sheets and sheets of paper.
The lab do a great job, they usually identify the most likely recipients and they'll usually
with a indicate where there is an antibody there but you still actually have to go through
manually and check it and quite often you're ringing back to the lab saying you know, is
what you said really true, can you double check, can you make sure that this cross-match
is okay, so it's quite a business and I'd like to, I mean I don't work in the lab obviously
but the degree of professional service we get from the tissue type of lab, I'd say nice
things about them because they're here, it is fantastic.
But I mean these are people that honestly know the HLA system and know these names that
are attached to these sequence of numbers that Rhonda was talking about and feel take
a great degree of pride in being able to find a compatible organ, particularly if they're
waiting for a period of time.
Absolutely, yeah.
Do you want to speak to that?
Yeah, no I think, I mean the lab staff, like I said they're all very dedicated and they're
a wonderful team of people and they work extremely hard to, to A have the knowledge base, they
have to do a lot of, we always, a lot of study, we say to people when they start in the lab
this is a very interesting job, science nowadays can be a bit automated and you sort of put
a sample on one end and get a result out the other and this particular field you get to
learn a lot as you go but we also are very demanding and we expect people to have to
study and learn and learning the HLA gene, it was easy when I started, there were only
12 genes.
That was a long time ago, I was a child and of course now there's over 8,000 and as we've
gone along we've understood better the degree of differences at the nucleotide at that very
small DNA level between individuals and we know that the immune system is really, really
clever, it can just work out this one little difference here can have a profound effect.
So the lab takes a lot of pride and a lot of care to get that information back to the
clinicians and to talk to people like Toby and the other clinicians about the antibodies,
about the HLA matching and I mean for some of the younger staff who are on, clearly it's
easy for us as we've worked for a long time but the new ones coming in, they've done a
couple of years, they're in the lab, they're in there by themselves at 3am, they've got
very, lots of things happening, the liver people are ringing, the lung people are ringing,
the kidney people, they're ringing as well, everybody's in there, everyone's there trying
to get the answers and sometimes they'll sort of say I need to consult with someone and
there's a whole team of us around the country that are just on call all the time for any
consult, for any information about this system and because the HLA system, it's the most
complex system in man, there are no other gene systems as complex as this one and it's
designed to be because it's got to work out all those very little details amongst every
virus and every pathogen that we ever come up against.
So yeah, there's a lot of work and people are very keen to help, everyone will help,
if we have a difficult dinner on the night people just get up and go into work and the
other day I went to work and everyone was still there from the night before and we let
that shift go home and then someone else took over and so it is very much, that's the primary
focus is to get that graft, that organ into the patient, the best possible outcome.
So that's what they do.
And so then the timeline, we have Sam for instance waiting here prepared, ready to go,
what kind of timeline are you working to, to have everything settled, for instance Toby,
I wonder you too, like to make sure that then that first incision can be made I guess.
It varies organ by organ and lungs we try to get in as quickly as we can, sort of six
to eight hours at sort of maximum if we can avoid having them out of the body that long
is what we try to do, although there have been some very interesting new developments
in the last couple of years pioneered at the Alfred Hospital that was mentioned before
about resuscitating lungs on a, if you like, on a scaffold or on a rig that it can actually
improve their function, if you like, precondition them before they get transplanted and that's
Greg Snell over there, some fantastic world leaders in Australia doing that sort of stuff.
So that's a recent advance, it's been very good for the kidney or old kidney, we can
keep them, I've seen them out for 24 hours and expected them not to work and then they
go and they work straight away.
And then I've seen them that we've transplanted four hours and they shut down for six weeks
so it's, you know, we can't predict it.
And obviously the liver team, we like to get the liver transplant in as quickly as we possibly
can so that the best surgeons are available to do the job and they're rested.
We really don't like doing operations in the middle of the night if we can possibly avoid
it, we much rather do them at, you know, six or eight o'clock in the morning when everybody's
awake and ready to go so it's not quite like you see on house or anything like that, it's
a little bit more controlled.
I would have said.
Yeah, exactly.
Okay, well look, we're going to take a short break now for about 10 or so minutes so feel
free to top up your drinks and take a look at the Book of Life as well that we have,
I think, over here, that's the Donate Life Book of Life which has stories of donor family
members and their people who donated and also transplant recipients in it and then we will
come back and we'll hear the final instalment of how the transplant takes place.
Thank you.
Thank you.
