The Nephrology Department at Christchurch Hospital provides regional nephrology services for people in Canterbury, South Canterbury, and Westland, comprising general nephrology, acute dialysis and chronic dialysis (CAPD and home haemodialysis). The department also provides Renal Transplant Services for people not only in Canterbury and Westland but also Otago and Southland.
The staff consist of five consultant nephrologists, two registrars, a house officer, a dialysis nurse manager, dialysis nurses, dialysis technicians, two secretaries, and a computer systems manager. We also have two renal transplant co-ordinators, a predialysis educator, a research/clinic nurse, a psychologist, a clinical nurse educator, a vascular access nurse, and an administrative officer.
Dr David McGregor
Dr Penny Hill
Dr John Irvine
Dr Nick Cross
Dr Suetonia Palmer
Ms Wendy Cuthill
Ms Kimberley Reimers
The registrar posts are suitable for advanced training in nephrology under the auspices of the Royal Australasian College of Physicians. See our careers website at www.cdhbcareers.co.nz
The Dialysis Service provides both haemodialysis and CAPD. Haemodialysis is carried out in either the Acute Dialysis Unit or the Home Dialysis Training Centre, each of which has 5 stations. Which unit visitors dialyse in is dependent upon department workload.
Operational hours are between 08:00 to 15:30 hours Monday to Friday.
All dialysis must be completed within these times unless special arrangements are made. Meals are not provided during dialysis.
A minimum of 2 months notice is required to book visitor dialysis unless special arrangements have been made with the Manager, Dialysis Services.
All visiting dialysis patients must have documentary evidence of negative status for hepatitis B, hepatitis C, HIV and multisite MRSA.
MRSA swabs must be taken from the nares, groins, perineum and any open wounds or areas of dermatitis. A 2 day salt swab enrichment broth to enhance the recovery of MRSA must be included.
These tests must be completed within one month of the proposed dialysis in Christchurch. All patients will be rescreened at the time of their first dialysis.
A full clinical and dialysis summary is required prior to confirmation of the booking.
Unless a reciprocal health care arrangement exists between New Zealand and the country of origin of visiting patients the charge per dialysis is $NZ650 inclusive of Goods and Services Tax (GST).
Further enquiries and booking should be directed to the Nurse Manager, Dialysis Services.
The Department of Nephrology has an active clinical research programme and has close links with basic and clinical researchers in Canterbury District Health Board and the Christchurch School of Medicine.
Current areas of research activity:
The Department of Nephrology co-ordinates the medical and surgical assessment of patients who are being considered for a kidney transplant.
For nearly thirty years, people suffering from kidney failure have had two options for life sustaining treatment – either have dialysis (a process that removes waste products and fluids that healthy kidneys remove from the blood stream.) or have a kidney transplant.
There are two sources of kidneys.
Only one kidney is transplanted into each recipient. Therefore a deceased donor may be a donor for two kidney recipients. In New Zealand 300 people on average are waiting to have a kidney transplant each month. About 50 of these patients live in Canterbury, Otago and Southland. On average each person will wait about three years for a transplant because in any one year there are not enough kidneys available to transplant. In 2003 74 kidneys were transplanted in New Zealand.
Patients who receive a transplant that works well (80 – 90% will be working well a year after transplantation) almost always find life more enjoyable. Kate, who had a transplant after three and a half years on dialysis, is feeling better and has a great sense of freedom. “It’s been such a relief. When you have to have dialysis, everything seems to revolve around that process which happens in three eight-hour sessions a week”, she says. “Now I’ve got my life back again. I don’t have to plan everything around dialysis. It makes me feel quite humble when people offer something like this which makes such a huge difference to someone else’s life.”
There are many people who have benefited from the generous decision of families who have said yes to organ donation. Transplant surgeon, Professor Justin Roake, hopes that New Zealand can significantly improve its donor numbers. At present about 12 people in every million of population become donors, but in some countries like Spain the figure is more than 30 donors per million. Audits are currently being done to identify reasons for a low donor rate in New Zealand.
“We have a driver’s licence system where people indicate on their licence whether they are prepared to be an organ donor after a fatal accident or stroke, that is if they are declared “brain-dead” while being cared for in an intensive care unit”, he says. “But the time when the relatives are asked about organ donation is an emotional time, and for many it is a subject that has not been discussed in the past.”
“This is why all those involved in organ transplants stress that it is most important for people to discuss with their immediate relatives their wish to be an organ donor. This often means any objections from relatives are sorted out beforehand.”
Professor Roake firmly believes that more could be done to reduce the waiting time for the 300 people who, each month, are ready to have a kidney transplant. While we do 30 transplants a year in Christchurch, only 16 or so of these are transplants from a deceased donor, and we have a waiting list which isn’t dropping, as each year new patients are considered suitable for transplantation. We have to work more on educating the public about the huge difference a healthy kidney can make to someone’s quality of life”.
A previously well person who has suffered severe and irreversible brain damage ( usually from an accident or brain haemorrhage) and admitted to an intensive care unit and after careful assessment is considered to be “brain-dead”. People up to the age of 80 will be considered for organ donation and up to 85 years for corneal donation. However, the age and medical condition at the time of death will determine which organs and tissues are suitable for transplantation.
Individuals can indicate their wish to be an organ donor on their driver’s licence. However the most important step is to discuss organ donation with family or your power -of attorney to let them know your wishes.
In practice, medical staff will not remove organs unless the family agrees and permission is granted.
Two patients could receive a kidney each and up to seven other people could receive other organs or tissues for transplant from one donor.
Most religious groups generally support the principles of organ donation. If any individual has concerns about his or her religion’s position, then a member of the clergy could be consulted.
No. Most organs and tissues must be retrieved before a will can be read.
No. In New Zealand organ donation is considered a gift and the buying and selling of organs is illegal.
No. Donors receive the same high quality care that non-donors receive. Medical personnel must follow strict guidelines before death can be pronounced and the donor’s organs and tissues can be removed.
(This definition is adapted from information provided by ACCORD – Australian Co-ordinating Committee for Organ Registries and Donation)
In most cases it is easy to tell when someone has died; they do not breathe or move, nor have a pulse and their skin changes colour because blood is no longer circulating. This applies whatever the cause of death. When someone is dead due to brain death, the brain stops functioning and will never function again. It means there is no supply of blood or oxygen to their brain, the brain cells die and cannot grow again or be replaced.
However, the person will be in an intensive care unit connected to a mechanical ventilator (breathing machine) which pumps oxygen into the lungs making the chest rise and fall. Some of the illnesses that can result in brain death are, head injury, bleeding into the brain, brain tumour and brain infection.
The prospect of a long wait on the transplant list often leads patients, their family and friends to think about the possibility of a transplant from a living donor. There are many issues to think through. Most patients are hesitant about asking a family member or friend to consider donating a kidney. Family members and friends may be concerned about the risks involved. However the thought that a successful transplant may be possible is often a strong incentive for many to consider making a kidney donation. In 1999 14 patients received a single kidney, in Christchurch hospital, from a relative, partner or friend.
The Department of Nephrology co-ordinates the assessments of potential living donors for potential recipients who live in Canterbury, Otago or Southland and for patients who will be transplanted in other hospitals, both within New Zealand and overseas.
The first step for any potential donor is to have his or her ABO blood group identified and to send a paper lab copy of the result to the renal unit that cares for the potential recipient so that the unit staff can check that the potential donor and the potential recipient are ABO compatible.
In Christchurch we have an information booklet for potential donors to read:
A kidney transplant is one of the treatment options for most patients with end stage kidney failure. Healthy kidneys for transplantation come from either a previously well person who has suffered severe and irreversible brain damage (a deceased donor) or from a healthy living donor. The transplanted kidney can then perform the function of the diseased kidneys.
Every year there are many more people waiting for a transplant than there will be kidneys available. Most patients can expect to wait for many months, even years, before a kidney becomes available for them.
The prospect of such a long wait often leads patients and their relatives to think about the possibility of a living donor transplant. Most patients are hesitant about asking a family member or friend to consider donating a kidney. Family members and friends may be concerned about the risks involved. However, a successful transplant will mean the end of dependence on dialysis and the return to a more normal and healthier lifestyle and this is a strong incentive for many to consider making a kidney donation.
If you are thinking about giving one of your kidneys, you should take all the time you to need to think over the information that you will be given, before you make up your mind. The decision to donate a kidney is an important one.
Some people make the decision instantly with few worries or concerns. Others go through some soul-searching before deciding.
Remember the only “right” decision is the one that makes you, the potential donor feel comfortable.
There are several people with whom you could discuss donation including:
The prospective donor must be over 18 years of age (or over 21 years of age for a non-directed* donor) and be a fit and healthy person with two normal kidneys. In general donors must not have high blood pressure, cancer, diabetes, kidney, liver or heart disease.
There is no strict upper age limit but as there is less chance that an older person will pass the medical examination necessary before donation is judged to be safe, a potential donor must be under the age of 65 to start an assessment.
People considering donation, who are over-weight, will be asked to consider weight reduction before tests and assessments are started. A height and weight ratio determines a person’s body mass index (BMI). Donors must have a BMI of 30 or less. Your practise nurse, GP or transplant coordinator can calculate your BMI for you. If you are motivated to lose weight and would like some professional assistance the transplant coordinator can refer you to a hospital dietitian.
It is necessary for any prospective donor to have an ABO blood group compatible with the potential recipient.
Inherited factors, called HLA antigens, are important in transplantation. Identifying these antigens, which are located on the surface of white blood cells, is called “tissue-typing”. A close blood relative, usually a parent, brother or sister, may be the most suitable donor. Children inherit a half set of HLA antigens from each parent, which means that a parent and child will have at least a half set in common. Brothers and sisters may be a perfect match, a half match, or have no HLA antigens in common. Aunts, uncles, cousins or other relatives may wish to be considered but may have no HLA antigens in common with the potential recipient.
Where there is no blood (genetic) relationship between the prospective donor and the potential recipient there are unlikely to be any HLA antigens in common.
However it is possible for adoptive parents, husbands, wives, partners or even close friends to consider having tests to see if they may be suitable donors.
It is also possible for someone to consider altruistic donation. In such cases the kidney would be allocated to the best tissue-matched and low-risk recipient.
A prospective donor must be able to make up his or her own mind about kidney donation. There should be no pressure from others nor any financial incentive offered to encourage donation.
For the recipient this means that a planned transplant:
The Nephrology Department will coordinate the tests and assessments, which will take six to nine months. A date for surgery will not be available until all the tests have been completed.
This is an operation that will be performed on someone who is in good health and does not need a surgical procedure for his or her own health.
It means you will have tests and procedures done that otherwise would not be necessary. There is the possibility that these tests may show up an abnormality that could have remained undetected. The results of these investigations sometimes show that you cannot donate a kidney.
You will also need to take time off from work to attend appointments and several weeks off work after the operation.
If you are able to donate one of your kidneys, the remaining kidney should be sufficient for your body’s needs.
While most donor operations are straightforward, complications sometimes arise. The surgeon will discuss these with you before you decide to proceed.
Specific complications that may arise include:
If you smoke, you should consider stopping to reduce the risks of chest complications, thrombosis (clots) etc.
Women on oral contraceptives should consider using an alternative method of birth control for three months before the operation.
Any operation involves some pain, but this is managed by modern pain-relieving techniques. You will be given detailed information on these by the anaesthetist.
Death from kidney donation is extremely rare. Overall the risk of dying from a donor nephrectomy is 0.03%. To put this into perspective the risk can be related to the risk of dying in a motor vehicle accident which is present each and every year. In three years the risk of dying in a car accident on the open road is about 0.05%.
There is a potential risk that a kidney donor may subsequently develop kidney failure and require dialysis and/or a transplant. The risk of this occurring is 0.11% – which is actually lower than the expected incidence for the general population.
There are two types of operations to remove a kidney:
For an open nephrectomy, the surgeon makes an incision about 25cm long horizontally below the ribs, and cuts through the abdominal muscles. Please note: At Christchurch Hospital, the procedure to remove a kidney does not involve the breaking or removal of ribs.
During the laparoscopic procedure, the surgeon makes 3 or 4 small incisions in the abdomen to allow the insertion of surgical instruments and a small (8-10cm) incision just above the pubic bone to allow the removal of the kidney.
The laparoscopic procedure should be less painful and donors recover more quickly.
However it will not be possible to tell you whether you can consider a laparoscopic procedure until the surgeon has reviewed the CT scan and assessed you.
Even if a laparoscopic procedure is planned the surgeon will ask you to consent to the operating being changed to the open procedure if this should become necessary during the course of the operation. Generally laparoscopic surgery is very safe but like open nephrectomy, deaths have been reported following this surgery as well. As mentioned before the risk of a donor dying is about 1 chance in 3000.
When the date is finalised you will receive a letter from the transplant coordinator confirming that the operation is being planned for a specific date. The coordinator will also send you a blood test form for a specific date to enable the lab to again perform the white blood cross-match test. The Urology Department will send you the date and time for your admission to hospital.
You will be admitted the day before the operation. You can expect to be in hospital for 5 to 7 days after an open nephrectomy and 2 to 3 days for a laparoscopic nephrectomy. You will be discharged when the surgeon considers that it is safe for you to go home. You will be asked to come back for the urology outpatient clinic about six weeks after the operation. You will be offered long-term follow up.
Most kidney donors recover quickly after the surgery and are able to go back to work and other activities within a few weeks. The length of time off work depends on the type of work you do and the type of operation you have had. You should avoid heavy lifting, digging, and playing golf for about 6 weeks and aim to be back doing everything you normally do by 3 months after the operation.
As mentioned before, one healthy kidney is enough to provide for normal health. Having one kidney does not change life expectancy or increase the risk of getting kidney disease. Of course, other problems might arise in the remaining kidney, for example, infection or a kidney stone, but the chances of this happening are quite small. Living with one kidney does not interfere with a woman’s ability to have children.
We know that a year after a transplant operation about 9 out of 10 kidneys transplanted from a living donor will be working well. Most of these continue to work well for 8 to 10 years. Some people have a transplant that is still working well after 20 years.
What we cannot tell you is whether your recipient will be the one person out of 10 whose kidney is not going to work. Unfortunately some kidneys are lost through rejection, infection, or blood supply problems.
Before donating a kidney it is important that you consider what your feelings would be if the transplant should not be successful.
The costs of the tests and the surgery will be met by the hospital. Travel costs will be covered if you live outside Christchurch. Financial matters are best discussed with the social worker who works with the Nephrology Department.
There may be assistance with any loss of income or extra childcare costs you have because of the operation. (Refer to Work and Income Leaflet entitled “Financial assistance for live organ donors”). In general, medical insurance companies do not deny cover for subsequent unrelated conditions to people who have previously donated a kidney. If you have any concerns about future entitlement to private health insurance, you should discuss these with your insurance company.
Most patients who have irreversible kidney failure can be considered for a transplant. They must be in relatively good health and willing to undergo assessment.
A member of the transplant team considers all patients who start dialysis for assessment. Some patients may have too many other major medical problems, for example: severe heart and blood vessel disease. Having a transplant may pose increased problems and dialysis may be a better long term treatment option.
Some patients may choose not to be assessed; others may be found to be surgically unsuitable. Before routine tests are performed, medical investigations are needed to make sure that the patient is fit to have a transplant. These will include:
All patients have:
All patients are advised that living donor transplants are performed at Christchurch Hospital and that both related and unrelated people may be potential donors. The assessment of a potential recipient for a living donor transplant can be started before dialysis treatment begins.
Red blood cells have complex chemical substances on their surface. These substances are different for each blood group. The blood group system, which is important in transplantation, is known as the ABO system. Within the ABO system people can be one of four types – O, A, B, AB.
Structures usually proteins, which can be detected by the immune system. If the body is exposed to foreign antigens, for example from a blood transfusion or a pregnancy, it can start an immune (fighting) response and form antibodies.
This term is used for donors who intend to donate a kidney to someone that they do not know.
Antibodies are proteins present in the blood that detect a foreign antigen. If the foreign antigen is detected at a later time the body is ready to destroy it.
This is done in the laboratory. The serum (the clear liquid in blood) of the potential recipient is mixed with white blood cells of a potential donor. If there are antibodies in the serum that damage the cells then this potential donor would be unsuitable for this recipient.
Computer tomography enables images of the inside of your body to be obtained harmlessly and painlessly. The specially designed system has a rotating xray source, moving around the body, emitting a narrow xray beam.
An ECG is a recording of heart electrical activity. Electrodes, pads with wires linking them to a recorder, are put on the chest, arms and legs. These electrodes pick up the electrical signal from the heart, transfer it to the recorder and a graph is printed out. It is a painless test.
Human Leukocyte Antigens are found on the surface of white blood cells. They are there to help the body regulate its immune response and are important for the body to survive. They also indicate whether a transplanted kidney is likely to be tolerated or rejected. A half set of HLA antigens is inherited from the mother and a half set from the father.
A scan that is performed in the Radiology Department. Ultrasound is high frequency sound that is beyond the range of human hearing. A probe is moved over the skin, sending and receiving ultrasound signals, which are changed into images of the kidneys and bladder. This is a painless procedure.
Page last updated: 26 February 2019
Is this page useful?