Cross-Matching Explanation

Further to the previous post, I've now had a sensible explanation for the need for cross-matching blood immediately before the operation: it's to identify suitable blood for possible use during the operation as a transfusion.  If they don't do this beforehand then, in an emergency, they would have to use blood which was "probably" the right match but may not be the best match; the analysis takes a few hours and in an emergency they don't have that time to spare! Obvious really, innit? Why can't people tell you the simple answer in a simple fashion?

Possibly there might also be a cross-match with Tim's blood but, as was explained to me, this is more of a formality as there is no likely reason for either of us to have suddenly produced antibodies, both being blood group O (universal donor).

Anyway, we're off in a couple of hours to London to avoid the morning traffic tomorrow - I wouldn't want to be late for admission at 10am due to the feared London rush hour (which seems to last all day these days), and neither would I want to leave here at 6am.

See you Tuesday, Brother!

"I'll see you next Tuesday then, don't be late."  I think that was the moment yesterday when it hit home to both of us that we are almost there.  It's 20 months since I volunteered and at times things have moved slowly but the last few weeks have rushed past.

We were at the hospital yesterday, and it was the last time for me as the operation will be performed at a larger (and better known) hospital nearby. The purpose of the visit was, as ever, for some more blood samples; these were the ones for the last minute cross-match.  This had puzzled me a lot as no cross-match was done at the start of the process, which seems odd for such an important thing.  This has been explained to me and I think it is something to do with the fact that we are both blood group O, so there are no antibodies present, neither has Tim had any introduced by any treatment. (You can tell I am still a bit puzzled by this.)

Anyway, asuming that is still clear (and there's no reason why not) then we are all systems go to turn up on Tuesday for admission starting with a set of very last minute tests and various interviews/meetings.  They often operate on two pairs on the same day but we are the only pair being done next Wednesday.  This is good because it means there's no issue of being second and having to wait around until noon, so I'll be going down between 8 and 9am with Tim following at some suitable point during my operation.

Life has been a bit hectic as I have been finishing and handing over lots of jobs.  I think I'm finished outside but inside the house still has a few little tasks, and my churchwarden duties (of which there are a lot) are getting dumped on anyone I can!

It now seems that I am expected to hang around near the hospital for a few days until I see the surgeon again; this should now happen on the following Tuesday and, if all is well, I will come home that day. I'm grateful to another of my brothers for looking after both of us for that time - apart from accommodation I think he is also providing a taxi service for Jane to come and visit me (but we'll know more about that on Tuesday).  After I come home, I think they intend to transfer my care to my local transplant centre. I am very happy with this as I was treated really well by them when they did all my initial tests, and it will be good that they have the interest in my long-term care.

HTA Interview

Getting really close now - less than three weeks.  Yesterday was the HTA (Human Tissue Authority) interview.  They have a legal duty to be satisfied that I am under no duress or coercion, and not being rewarded in any way for donating. As part of this, you have to prove your relationship to the recipient, which we did with full birth certificates (NB not the abbreviated one as you need parents' names on it) and lots of old wedding photos for ourselves and some of our siblings.  We have often had a photo taken at these events showing the seven brothers in order, with the new bride in the middle - never thought these would come in handy!  The only worry I had was that I don't look as young as I was, so I also took an old passport to prove that it was me in the pictures.

The HTA also want to be assured that the donor understands the risks of donation and the possible things that could go wrong, so a decent read of the four page HTA document is required, as well as listening carefully to the things that the surgeon said in our earlier interview. It all went well and the interviewer said that she was satisfied, so that's a done deal unless there was something fundamental that she forgot to ask.  I also had a few pre-op things done - some MRSA swabs, some more bloods (as always!) and a fasting abdominal ultrasound, which was done by a doctor and he pronounced that there were no issues seen.  NB I don't know why this was needed - did they think my insides might have changed since the last one in August last year?

The next step is the final cross-match check which will be done six days before the op - another visit to London - and then everything else will be done the day before the op.

Starting to feel a bit nervous or apprehensive - the same sort of feeling as the imminent arrival of a long-awaited exam day.  As I've said before, this is all the sort of thing that I had expected as a natural consequence of making the donation decision last year, so it's no surprise really, just a realization that the summit seen from afar is actually getting quite near!

Now I'm properly in this process

At last, I have had the first interview plus had a load of blood samples taken.  It seemed to me that things were going a bit slowly so it was good to spend a couple of hours at my local hospital's transplant centre and get things started properly.  It's also quite a funny feeling going for a hospital appointment when you are not actually unwell at all; then you get treated very well, as though you are valuable and an important person - is this now a mark of the NHS for all patients or are donors given special treatment?  It was when I saw a stamp on my documents saying "Potential Live Donor" that I realised that perhaps a live donor is indeed valuable not just to the recipient but to the NHS, due to the fact that the donation will save the NHS thousands in the coming years. 

I had thought that the slow start was due to me living some way from London, and thus unable to easily attend the same hospital, but it seems that the recipient, my younger brother, has also only just started the actual transplant process.  The good news he has is that his kidney function (eGFR) has actually gone up from 17 to 19, so things are looking a little less critical for now.  He spent most of  last year stable in the mid 20s.  I understand that at 15 they want to be actually organising the transplant so it can get done before the need for dialysis which starts when it gets down to 10.  If the recipient avoids dialysis then apparently it reduces the possibility of rejection and improves the chances of everything staying healthy for longer, just as having a transplant from a living donor (LD) is more beneficial than a cadaveric donation (i.e. a dead person).

So, now the recipient and both potential donors have all had the blood samples taken for tissue typing and cross-matching.  This will get done in the next two weeks and then a decision needs to be made about the donor as they want to go ahead with just one at a time.  If just one of us is suitable then there's no real decision as we are both already willing and committed.  If we are both suitable, I think that it's down to us to decide who should be Number 1, and I have no idea how we will make that decision apart from prayer.  I think I've been told that it's unlikely for both donor brothers to not be suitable at this stage, but if that was the case then Tim is back to square one looking for other potential donors (of which there is already at least one of the right blood group, although not a blood relative). 

One question which was asked yesterday was how I felt about the idea.  This is very hard to put into words, but I have no worries and no concerns.  Why would I not offer?  Personally, it seems to me that if I can, I will; no question. I imagine that Nick, the other potential LD, has the same feelings as myself about it, which basically is that "of course I'll do it for my brother - I would hope he'd do it for me" etc.  By law payment is not allowed and of course one wouldn't charge a brother anyway, but I don't even think that any thanks would be needed to be said as I will know how he feels afterwards.   I know that I already feel very emotional about what this would mean for Tim - in fact, calling him to offer a kidney was a curiously hard phone call to make - I could hardly get the words out because of the emotional feeling.  To me it is almost a foregone conclusion - it's down to me and I have no hesitation in volunteering.  I do feel quite disinterested and detached from the issues which people mention; I think that having effectively made the decision already means that I just want to keep going down this road one step at a time, as far as I can, and I would not be happy in myself if I chickened out for any selfish reason.  Why would I not want my brother to be healthy?

Diverted by a Colonoscopy

Well, I could now give full details of what is involved in a colonoscopy, but I'll spare you the details.  Suffice it to say that it's quite odd seeing your own insides on a TV screen.  The staff were all wonderful and I have nothing but praise for the way I have been treated at the local hospitals.  The procedure itself actually wasn't too bad - the worst bit was the preparation for it when you twice swallow a solution of magnesium citrate.  If you know what that does, then you will share my discomfort; if you don't know, google it and be happy it's not you.

They removed a single polyp from me and that had to be sent for biopsy.  I was told that it looked OK based on the doctor's knowledge and experience of these things, and it was duly confirmed as "normal" just over a week later.  They'll want me to go through the whole thing again in three years just to see if anything has changed.  So, right now, I'm fit and healthy after that scare and I'm back on track in the kidney donor process.

The speed of this whole thing has been remarkable: I had the letter with the failure result on a Wednesday, was seen for assessment the following Tuesday, underwent the (slightly unpleasant) "further investigation" on the Thursday of the week following and received the biopsy result eight days later (if no samples are taken then you are told you're clear at once).  That made 23 days from start to finish, including Easter.  I certainly cannot complain about the NHS!

I understand that the next step is tissue typing and cross-matching to see if my brother and I are compatible.  The transplant nurse in London has persuaded another local hospital near here to do this to save me trips to London and this is now booked for next week. If this is OK then there are lots more tests they want to do, about which I have no detailed knowledge at present.  I know they will also want to assess me mentally to make sure I know what I'm doing and also to be sure that I'm not being paid...!

In the colonoscopy preparation meeting I was asked how I felt about the situation.  I didn't really know at first but realized that in fact I was quite annoyed as the threat of cancer was getting in the way of the possibility of helping my brother.  That question did make me wonder about how I felt about undergoing a (personally unnecessary) major operation voluntarily, even to help my younger brother.  To my surprise I realized that I'm not in the least bit fazed about it; it just seems part of life in the same way that I accepted the possibility of having cancer myself.  You've got to die of something, after all!