From bruises to blood donation, menstruation to mozzies, the first season of It Can’t Hurt To Ask focuses on blood.
Would you donate your organs to give someone a second chance at life? Organ donation is a complex process and in this episode, we learn about why only certain organs are a match for people in need and how blood types play a big role in matching organs to the perfect recipients.
Dr Ross Francis walks us through the donation matching process, while Gary Torrens takes us through how kidney transplants are performed through the Queensland Kidney Transplant Service and shares his experience working in the National Indigenous Kidney Taskforce. Then, Queensland woman Amber Williamson tells her personal kidney transplant story, sharing how a living donation from her dad has changed her life.
How long does a donated organ last? What are the impacts of organ donation for recipients? Which organs can you donate while still alive? Listen to find out!
Featured in this episode
Dr Ross Francis
Dr Ross Francis is transplant physician and consultant kidney specialist based at Princess Alexandra Hospital in Brisbane. A big part of his job is overseeing the match making of donors and recipients. Dr Francis was also the chair of a national group involved in rolling out a major innovation in the space called virtual cross matching, which makes the testing and matching process quicker. In this episode, he breaks down the matching process for us and explains what happens behind the scenes.
Gary Torrens
Gary Torrens is the Clinical Nurse Consultant for kidney transplant at the Princess Alexandra Hospital in Brisbane and for the Queensland Kidney Transplant Service. He is a proud Wahlubal man from the Bundjalung Nation in northern New South Wales. Gary helps guide patients at Princess Alexandra Hospital through the transplant process, including determining if it’s the right option for them. In this episode, he explains why blood type matters, the patient experience of transplants and his work with the National Indigenous Kidney Taskforce and Clinical Excellence Queensland to take the transplant education programs on country.
Amber Williamson
Amber Williamson is a kidney transplant patient and advocate who has been living with kidney disease most of her life. She had a transplant almost 20 years ago, donated by her father. In this episode, she talks us through her diagnosis and surgery, what life has been life since, and why organ donation not just changes lives but saves lives, too.
Episode resources
Donate Life
Did this episode spark your interest in organ donation, or remind you to sign up to become a potential donor? You can learn more about organ donation in Australia and sign up as an organ donor at Donate Life.
Kidney health
In this episode, we feature the story of Amber, who received a kidney transplant from her dad after years of kidney disease. Want to know more about how kidneys work? Listen to the Kidneys episode of our previous podcast, My Amazing Body, and check out Kidney Health Australia’s website for information about keeping your kidneys healthy.
Queensland Kidney Transplant Service
The Queensland Kidney Transplant Service (QKTS) is for people who may be suitable for a kidney transplant and provides ongoing care to people with a transplanted kidney. You can learn more about the service and find resources about preparing for a kidney transplant, what happens during surgery and recovery after transplant surgery on the QKTS webpage.
Episode transcript
Vox pops: Where do donated organs come from?
Can I choose who to donate to?
What’s it like to receive a donated organ?
How long does a transplant last?
Narrator: Welcome to It Can’t Hurt To Ask, the heath podcast that answers your questions, concerns and curiosities.
From periods to mosquito-borne viruses, we’ve covered a lot of blood-related topics this season. And for our final episode, we’re deep diving into organ donation.
Hi, I’m Lauren and this episode was recorded on the lands of the Jagera and Turrbal people. We acknowledge the Traditional Custodians and pay our respects to the Elders past and present.
Remember, whatever you hear in our episodes is general information. Always speak to your doctor about your individual circumstances.
Ready?
Organ donation is an incredible process that literally saves lives. But many of us might not be aware what’s involved and the role our blood plays in the matching process.
So, today we’re going to hear from a few people who offer insight into different parts of the process; from matching donor and recipients, to what it’s like to undergo a transplant.
Let’s start with the basics, shall we?
As of December 2023 there were almost 1,800 Australians on the waitlist for an organ transplant.
Dr Ross Francis is a transplant physician – so this life-saving process is part of his every day.
Dr Francis: My name is Ross Francis and I'm a consultant kidney specialist based at Princess Alexandra Hospital in Brisbane.
Narrator: Donations can range from organs to eyes and even tissue. So which are the most common transplants in Australia?
Dr Francis: The most common would be kidneys across Australia. But the other organs that are commonly transplanted would be liver, heart, and lungs, and also pancreas.
I guess the rarest thing that we sometimes see transplanted, it's not done in Queensland at this stage, but we do occasionally see in Australia, would be intestinal transplantation. So for people who have had bowel failure, they'll sometimes get a very large transplant, often with liver and pancreas included as well.
Narrator: For context, in 2022, there were 713 kidney transplants in Australia, compared to just two intestinal transplants.
And of those almost 1800 Australians on the waitlist for a life-saving organ transplant, 80% are waiting for a kidney. The second most-in demand organ is a liver.
For this reason, we’ll mainly be looking at kidneys today, as well as the process generally.
There are many reasons why people who are sick or dying may need an organ transplant. This includes people with heart failure, lung, liver or kidney disease, as well as those who need skin or tissue grafts due to cancer or who’ve been in accidents.
And it’s not one person per donated organ either – one person may be able to donate several different organs so a single donation can make a huge difference.
But the complexity of transplant surgery depends on the organ.
Dr Francis: Kidney is probably the most straightforward in terms of the technical aspects of for surgeons, although I should point out that I'm not a surgeon. But liver, certainly the surgery for liver transplantation is much more complicated. And then as you move into the chest, I think it's also technically much more challenging with heart and lung transplantation.
When you have a kidney transplant, you're not taking out the patient's kidneys, you're adding an extra one. But if you're doing a liver transplant or a heart transplant, you have to take out the patient's diseased organ to replace it. And of course, that puts another level of complexity because if something goes wrong with the implantation procedure, then you haven't got a spare organ up your sleeve to replace it with.
Narrator: How are donors and recipients connected to each other?
A national computer system called OrganMatch manages transplantation in Australia. It’s basically a register of everyone waiting for an organ, whether that’s a kidney, lung or liver or whatever.
When a donor becomes available, their tissue type and blood group will be entered into the system. OrganMatch will then generate a list of suitable and compatible patients for that particular organ to go to.
Remember, there are no silly questions here. So, where do donated organs—in this case kidneys—come from?
While most organs come from people who have passed away, kidneys and part of a liver can come from living donors.
A living organ donor in this instance, involves donating a kidney to another person – usually a relative or a close friend who has end-stage kidney disease.
And why does compatibility matter?
There are two key factors that determine compatibility between donor and recipient. This applies to both living and deceased donors.
The first factor is your blood group. If you’ve listened to our Blood Donation episode, you might already be across this.
If not, don’t worry. Let me introduce our other expert, Gary Torrens, who’s going to give us a refresher.
Gary Torrens: My name is Gary Torrens. I'm the clinical nurse consultant for kidney transplant at the PA Hospital and for the Queensland Kidney Transplant Service. Also, I'm a proud Wahlubal man from the Bundjalung Nation in northern New South Wales.
Narrator: As a clinical nurse consultant, Gary helps guide patients at Princess Alexandra Hospital through the transplant process, including determining if it’s the right option for them.
We’ll hear more about this process soon.
For now, back to blood. Over to you, Gary.
Gary Torrens: Now there are four blood groups. There's O, A, B and AB. Now AB is the Powerball winner. That's won the 100 million last Thursday. They're doing very, very well. So, AB, they can receive a kidney transplant from any blood group okay so they could receive a blood group from O, A, B or AB.
So usually, people who are AB can be transplanted pre-emptively before they actually start dialysis, so, and it's probably the most rarest group as well.
So, the next blood group would be blood group B. Now blood group B can only receive a kidney transplant from someone who's donating that is an O or a B. So, if you think of that, the donor pool has gotten smaller, okay.
Blood group A can only receive from an O or an A. So, for them that pool is a lot smaller. And then if you are in blood group O, which is probably the most common blood group, you can only receive from an O. So, if you think about that, there is a lot of people in the community who are blood group O.
So, the need for blood group O is a lot more. So, the wait will be longer.
Narrator: Because of supply, your blood group also impacts the wait time. While it varies, currently, patients who are blood group B could be waiting up to two years. Blood group O, the rarest, could be five years.
The second step of matching is making sure tissue type is compatible. This is done through a process called HLA or human leukocyte antigen matching. These are molecules that sit on the surface of your cells.
Think of these as an individual barcode or a pin number that marks out who you are to your immune system. So, donor and recipient need to match up as closely as possible. Otherwise, the body will identify the transplanted organ as a foreign object and develop antibodies to fight against it.
This is when the body rejects the organ. According to Dr Francis, this is not uncommon.
Dr Francis: About 20% of patients would have some form of rejection and the risk is highest in the first three months. So, the medications that we have nowadays are very effective at preventing rejection and most of the early rejection we can manage very easily. But later out in many years or decades after transplant, we do see an increase in chronic, more slow rejection. So, it does contribute to the decline in function we see over many years in a lot of transplant patients.
Narrator: While matched blood and tissue types are important, advancements over the last decade or so means there are some cases where a transplant can go ahead despite incompatibility.
This is called an ABO-incompatible transplant.
Dr Francis: If you do have a living donor and your blood groups are incompatible, we can sometimes actually go ahead with those transplants by doing some additional treatment for the recipient to remove the antibodies from their blood. Unfortunately, it takes a few days to do that. We usually can't do that for a deceased person. But this does offer other opportunities for people with living donors.
Narrator: Transplants are no small matter. So extensive evaluation and testing is carried out on both the donor and recipient to ensure transplantation is safe and suitable for them.
For a living kidney donor, doctors want to ensure they’re not putting themselves at risk by donating. The process, made up of a series of tests and clinic reviews, can take anywhere from six to 12 months.
And about 50 per cent of people who start the process will be ruled out due to a variety of reasons.
The decision is made jointly by a team of surgeons, kidney physicians, nurses and allied health professionals.
Dr Francis: So, we work as a team really, and for the whole process of working up patients in order for them to go onto the waiting list to receive a kidney, they'll see both physicians and surgeons who will look at different aspects of their care. And then at the point at which you get offered a kidney, it will be one of the physicians who usually does the allocation. So, they'll look at the kidney that's on offer and they'll try and find suitable recipients on the waiting list.
And that's done through an algorithm. So, it's not that we pluck a name out of a list. There's a clear process to allocate those based on waiting time and how well matched the donor and the recipient are. Obviously, we don't get involved in the actual surgical process. That's done by surgeons in theatre. But then we would usually see as the physicians, the patient, as soon as they finished the operation, we'll go and see them in the recovery area. And we're really responsible for prescribing immunosuppressive drugs that are absolutely vital to stop patients from rejecting their new organ and also managing their fluids and salts and electrolytes in their blood in the first few hours and days after the procedure.
Narrator: So, what happens when a match is made between donor and recipient?
Amber Williamson: My name's Amber Williamson. I'm 48 years of age and I've been living with kidney disease most of my life. I have been blessed enough about 20 years now to have had the gift of life and had a kidney transplant, which was donated by my dad.
Narrator: Amber was 19 and a uni student when she was first diagnosed with chronic kidney disease, IgA Nephritis, which is an inflammation of the kidney.
Amber Williamson: Your kidney structure itself has all of these little holes and filters because the job of the kidneys is to actually regulate your hormones, regulate your blood pressure, eliminate waste from your body, and also regulate your water balance in your in your body and your electrolytes. And with my kidneys having this IGA nephritis, it meant that I was getting holes in my kidney structure.
So it's like going fishing. If you take a fishing net that has holes in the net, you can't fish. And that was what was happening to my kidneys. I had gaping holes in my kidneys and they weren't doing their filtration job that they supposed to do to keep me well.
Narrator: While her kidney function worsened faster than expected, Amber didn’t require a transplant straight away. It wasn’t until she was in her mid 20s and on dialysis, a procedure that removes waste products and excess fluid from the blood via a machine to mimic the kidney’s function, that the time came.
In Amber’s case, her family got tested. Her husband, brother and dad were all blood matches – O-positive to Amber’s O-negative.
Her Dad wanted to be the first, in case she needed further transplants later in life.
Amber Williamson: And he said, if you need another one Amber, I would be the first, and then you have some other options into the future. So, I thank my dad every day for saying that and being so supportive.
Narrator: Amber’s surgery took eight hours. So how did she feel going in? And how was recovery?
Amber Williamson: So, when I had the transplant, I remember saying goodbye to my family and saying goodbye to my dad, side by side we were, holding hands and just saying thank you, Dad, you're giving me a new chance. And when I came out, I cannot tell you how good I felt. I immediately saw my eyes had been red for three years and all of a sudden my eyes became white again. I looked like a different person. The green tinge that I kind of thought was a tan.
I got used to thinking it was a tan. I actually became pink and I just couldn't believe how different I felt. And what I realized is I'd been living my whole life compensating and I didn't realize that’s what a really good kidney felt like.
And the other thing about kidney failure, when you've been on dialysis for over a couple of years, I hadn't passed urine for over 24 months, so I had to retrain my bladder. So, when you're pumping in all of that fluid, I was constantly to the bathroom as well. So, it was quite a recovery time, over the next couple of weeks.
Narrator: The recovery can be an intense process.
A typical kidney recipient would stay in hospital for just under a week if everything goes smoothly. Once they’re home, there are daily check ins for the first few weeks, and then a few times a week for the first two months.
Long term, appointments can space out to every two to three months. While it may sound like a lot, it’s seen as a big improvement compared to dialysis, which involves going to hospital three times a week to receive treatment.
With a living donor, there’s a bit more flexibility in timing and organising the transplant from donor to recipient.
However, if a patient is receiving an organ from a deceased donor, things have to move quickly. This is because the organ starts to deteriorate without blood or oxygen supply.
Dr Francis: So once an organ's actually been taken out and is in preservation, you've really got about 24 hours maximum to get a kidney implanted into a recipient. And we try and keep it shorter than that, so we would try and keep that time down to 12 hours where possible. And for some other organs, particularly for parts of the lungs, those times are even shorter. So yeah, this all happens often in the middle of the night, unfortunately. That's just part of the job.
Narrator: Research is continuously being done to try and improve methods of keeping organs healthy while they’re waiting to be transplanted.
Dr Francis: People are trialling things like keeping the organs at a normal temperature, like 37 degrees, whilst flushing the kidneys or perfusing them with blood.
So, coming back to this topic of blood, that's another way that we might be using blood as a therapy for organ transplantation. It’s possible that we'll be able to extend the time that organs can be kept outside of the body before they're transplanted. Or we might be able to use that time to improve the function of the kidneys or to test them.
Narrator: Despite the odd hours, making that phone call to tell a patient they’ve found a match is one of Dr Francis’s favourite parts of the job… even if they’re often a little disgruntled to be woken up in the middle of the night before they know why!
Dr Francis: One of the nice things about my job as a kidney specialist or a nephrologist is that we look after people really for the whole life of their kidney disease sometimes. So, we'll watch people have deteriorating kidney function and have treatments like dialysis to keep them alive if their kidneys have failed and then go on to have a kidney transplant. It's lovely to see people's quality of life improved if they get a transplant and it's successful, it's just life changing.
Narrator: Another way experts have been able to make the matching process quicker has been through something called virtual cross matching. Dr Francis was the chair of a national group involved in rolling out these advanced processes in recent years.
Dr Francis: So, if you go back to the early days of transplantation, we used to do a physical cross match where we'd literally mix the cells from the donor with the blood from the recipient and look for whether the cells were getting killed. And this is very similar to how we started off with red blood cell matching for blood transfusion. And yes, this worked pretty well at picking out patients who had really high levels of antibodies that were going to be a big problem.
And of course, before those physical cross matches came in, we would see patients where the kidney transplant would be performed and the kidney would literally fail within minutes or hours of the procedure because we weren't able to detect those antibodies and they just destroyed the organ. So that was a big step forward.
Narrator: However, this method wasn’t sensitive enough and didn’t pick up all the relevant antibodies. The progression to virtual cross matching has helped this.
This technique tests the blood of patients waiting for an organ transplant and maps out all their antibodies. Oh, and if you want to hear more about the magic of antibodies, check out our dedicated episode.
Having the map means you no longer have to do the physical cross match and instead just test their HLA and tissue type and compare them.
Dr Francis: And if a patient on the waiting list has never had an antibody to any of those donor antigens, then they're safe to transplant. And that's what we'd call a virtual cross match because we haven't actually got anything, haven't used cells or the quid or anything to do that. It's just all done on a computer.
Narrator: A person can register to be an organ donor on the Australian Organ Donor Register (AODR) when they’re alive or their family may be asked for their consent once they’ve passed away – if certain criteria is met.
This is because – and partly why the pool of organ donors is so small - a person must die in hospital in specific circumstances, in an intensive care unit or emergency department, to be considered for transplantation.
Dr Francis: So only a select number of patients are suitable to donate. And of course, there are some medical conditions that would stop us being able to use some of the donor. For instance, if they have died of a cancer that might be potentially passed on with the organs, that wouldn't be suitable.
Narrator: The Queensland Kidney Transplant Service at Princess Alexandra Hospital in Brisbane is the only kidney transplant facility in Queensland.
In his role as clinical nurse consultant there, Gary Torrens, guides patients through the treatment options available, including whether a transplant is right for them.
Supported by the National Indigenous Kidney Taskforce and Clinical Excellence Queensland, recently he’s also led an extension of the transplant education programs on country, helping to increase equity and access to kidney transplantation for Aboriginal and Torres Strait Islander people.
It’s work he’s particularly passionate about and proud of.
Gary Torrens: So, I was able to take the whole team on country, to regional centres. The places that we went to were Townsville, Mount Isa, Cherbourg, Toowoomba, Woorabinda.
It's the first of its kind in Australia where it's been Blak led, being myself, my colleague Brett as a male. And then also we bring an Aboriginal Torres Strait Islander female as well to help cover cultural bases.
And then we bring the whole team out on country and do face-to-face education. And we tried a few different ways of doing things, but we, the last model that we did use was a big yarning circle and just keeping things very informal and doing things over a cup of tea and a feed. And sharing stories, sharing information, keeping things very personable, where the kidney specialists, they weren't the doctor and the surgeon wasn't the surgeon they were Uncle John, Auntie Nikki they were they were part of the team and everyone just got on very, very well and you could see a lot of experiences.
Narrator: As well as consulting and working on community, a rewarding part has been seeing some of the attendees go through their transplant journey and the impact on not just their health but their life, too.
Gary Torrens: But that's how we've, in the whole process so far, we've seen people that have gone through our sessions and have gone through the whole journey to be transplanted. I think our number would be at least 10 or 12 now that we have seen. And our plans are to go out and do a lot more.
And the key, one of the, a lot of the key thing from that as well is that the fact that they come down to us re-empowered and they, it's their journey and they're taking it by the scruff of the neck. They, they own it now and they, they're, they're accountable only to themselves and they know that and, power has been taken away from them for 250 years. And for a lot of people, the closing the gap is that working? It's, it's not the gap's getting bigger.
But, in this situation, a lot of people really want a good quality of life. They want to live longer. They want to have a better outcome for themselves. So, they, we give them all the tools to make that decision, all the thing, given the information and try and set up like a cocoon around them in their own, in their own backyard to try and have support networks around them.
Narrator: While a transplant does save lives, the health impact doesn’t end there. As Amber says, a kidney transplant is a treatment not a cure.
Amber Williamson: Kidney transplant is still an organ transplant. It's still a treatment option. It's not a cure. Transplants can or might not last forever. So, we need to make sure that we take good care of our own health and make sure that we really listen to how the professionals that who are giving us advice and try and do everything we can to prolong our life.
Narrator: Day-to-day management to look after her transplant involves taking about 19 tablets a day, including immunosuppression medication.
This helps suppress the immune system from rejecting the transplant and organ if it detects that it’s a foreign object.
Unfortunately, there are some side effects of medication like this.
Amber Williamson: One of the things that we suffer from in the kidney community is skin cancer and cancers. So, I've had a lot of plastic surgery. I've had cervical cancer, just low-level stages. But you really have to keep on top of all your health checks for everything, because now you're at risk of all these different kind of health problems. I think once an organ fails, it leads to other stuff going wrong in your body.
Narrator: Amber is passionate about encouraging open conversations about organ donation, both in her own life and through her consumer advocacy work with Metro South Health and Kidney Health Australia, an organisation that supports those with kidney conditions.
Amber Williamson: Once you have an organ failure, it can actually impact other parts of your body. And so, I suppose that's why, you know, having that conversation early about live donors, if there are people available, it's probably never going to be the patient that reaches out because it's too big to ask.
It's about family and friends saying, ‘Hey, can I do anything to help? What? How does transplant work? Can I help you?’ Because waiting on that waiting list can take such a long time and getting too many health problems, then it makes it harder to get a transplant.
Narrator: We’ve learnt a lot about the organ donation and transplant process.
Before we finish, let’s bust a few more myths and misconceptions.
Like how long does a donated kidney last?
Gary says about 99% of transplanted kidneys reach one year. The length after that can vary.
Gary Torrens: The five-year graphs survival we're looking at about probably 80 to 90 percent of kidneys make it to five years old and keep going. We look at if people look after themselves, they engage with the hospital, they manage themselves well, they troubleshoot well, they access supports, and also the elements of luck. We're looking at about probably 15 years out of a kidney. That's just an average number.
We do have people that maybe lose them after two or three years. We do have people that have had their kidney over 40 years, and we've got a few of those patients that are still with us and they're functioning well.
Narrator:
Thank you for listening to this episode of It Can’t Hurt To Ask. We hope you’ve enjoyed learning all about how organ donation and transplants work.
If you want more information, you can check out Donate Life. You can also find more helpful links, including for Kidney Health Australia and the Queensland Kidney Transplant Service, in the show notes of this episode.
Thank you to Dr Ross Francis, Gary Torrens and Amber Williamson and the team at Metro South for sharing their stories and expertise with us.
That’s it for this season of It Can’t Hurt To Ask, covering all things ‘In My Blood’. We’ll be back soon with a new season for you to treat your ears to.
In the meantime, you can dive back into our other episodes and find more helpful and entertaining health content on our social channels, @qldhealth.
If you’ve enjoyed this series, please rate or review it. Even better, share it with a friend, family member or colleague who you think would also enjoy this episode.
Until next time, bye bye. And remember, it can’t hurt to ask.