Special kidney procedure saved James’s life, with his brother’s help

A SPECIAL medical procedure performed for the first time in 15 years at Beaumont hospital saved the life of a Tallaght man suffering from kidney dysfunction.

The Echo spoke to Beaumont nephrologist Colm Magee, who explained how James Reynolds was able to receive a new kidney from his living brother Graham even though the two are different blood groups.

Having a family member stepping forward as a living kidney donor is a great option as it reduces the extremely long wait for patients on the waiting list.

However, according to Dr Magee, most people have incompatibility issues, whether it’s blood group or tissues incompatibility.

While James was blood group 0, Graham was blood group A, meaning that with a regular transplant James’ body would have rejected Graham’s kidney within the first 24 hours.

“Like in blood donations, blood group 0 is always the most difficult one,” explained Dr Magee.

“Someone who’s 0 can only take 0 blood or a 0 organ.” The procedure called “ABO incompatible living related donor kidney transplant” finds its way around it by making the recipient’s body able to accept the donor’s organ through treatment.

The levels of antibodies, which are responsible for the rejection of anything ‘foreign’ to our body, are lowered in the recipient’s body through immunosuppression and more specifically in their blood through plasmapheresis.

James underwent immuno suppression a month before the transplant and started plasmapheresis one week prior to the transplant.

People with kidney dysfunction are normally on dialysis, which artificially filters liquids and waste from the blood.

James Reynolds (left) and his brother Graham

Coping with so many treatments at the same time can be tough, but it’s the key to make the transplant work.

“Plasmapheresis is like a special form of dialysis,” said Dr Magee.

“It brings the blood group antibodies to a low level and when you have that period when the antibodies are low, and the patient is on the standard transplant medications, that’s enough time for you to get the kidney in.

“You don’t convert the patient to a different blood group, but you reduce their reactivity to the blood group they’re incompatible with.”

Speaking of the possibility of antibodies increasing again, Dr Magee said they would “typically increase a little bit in the first few weeks,” but that rejection rarely occurs if the patient has gone through the first week after the transplant with no issues.

“We consider the first two weeks a sort of ‘danger period’ and after that we’re generally much more comfortable.

“It’s very rare that the antibodies bounce back high, which would be the cause of rejection.”

Overall, the procedure is a very “complex undertaking,” involving kidney doctors, blood bank specialists, and specialist nurses for plasmapheresis.

It adds up to the several hours of surgery that both the donor and the recipient have to go through for the actual transplant, which was carried out by doctors Dilly Little and Neal Dugal.

Including the case of James Reynolds, who has been doing “fantastic” since his operation in October according to Dr Magee, this was the fourth time that the procedure was carried out in Ireland.

It became less common when Ireland entered the UK Living Kidney Sharing Scheme (LKSS), which allows an incompatible recipient from one pair to be matched with the compatible donor from another pair and vice versa.

Accessing such a larger population, typically through Belfast City Hospital, people in the Republic can find matching donors and recipients more easily.

“If you can find a swap where you don’t need to do any of this extra treatment, that’s always better,” said Dr Magee.

The Tallaght siblings had explored this possibility too but couldn’t find the right match throughout six months.

More chances might be available for patients who are blood group A or B, as they can receive from their own blood group and also from 0 donors.

Kidney transplants made more than half of all the organ transplants done nationally in 2024 according to a recent HSE report.

Out of 263 organ transplants,175 kidney transplants took place, involving 30 living donors.

To register your interest in donating, you can request an Organ Donor Card with the Irish Kidney Association HERE.