Cheese sandwiches and kidneys: The role of an Independent Assessor
- Bone marrow and PBSC donations
The little boy in his buggy beamed happily when I asked him what he was most looking forward to after he got his new kidney. ‘Cheese sandwiches!’ he shouted immediately. And then after a few seconds further thought “And going swimming!’
He was on dialysis with kidney failure. His dad was about to donate a kidney in the hope that his son could enjoy both those things and have the chance of a normal healthy life. I met them in my role as an Independent Assessor for the Human Tissue Authority (HTA).
Under the Human Tissue Act 2004 the HTA must give approval for every kidney donation from a living donor. In order to do this, the HTA train and accredit Independent Assessors (IAs) who interview both the donor and recipient before submitting a report to the HTA for their decision. Assessors work for particular hospitals and I carry out assessments for the renal department at Guy’s and St. Thomas’ NHS Foundation Trust.
I’ve been an IA for seven years. I am a hospital chaplain and before that was a tax lawyer in the City for many years so bring varied skills to the role. The one skill I’m not required to have is any medical knowledge although many IAs do come from a clinical background.
The purpose of each interview is to ensure that the kidney donor is giving informed consent to the donation, not influenced by any payment or reward and not given under duress or coercion. I explore the donor’s understanding of the proposed surgery and of the risks involved, as well as how they came to the decision to donate in order to confirm that they made up their own mind to do so. I must also ask specifically if they are getting any payment or any other reward for their kidney. This is usually the point at which a parent donating to a child looks at me incredulously, so I explain in advance that there are certain questions I have to put to everyone even if the answer might seem obvious.
Donors and recipients are often emotional and some arrive very stressed so it’s important that I try to put them at ease and conduct the interview sensitively. I usually do two to four assessments a month. An hour is allocated for each one and a room made available in the renal clinic. I’m acting as the ‘eyes and ears’ of the HTA, gathering the evidence they need to give legal approval on the basis of my report. The decision is theirs, not mine.
I also interview non-directed altruistic donors, who offer a kidney for a stranger without knowing who it will go to. I am always impressed by how selfless and calm they are. One told me “The question is not why I would want to give a kidney but why I would not, when I don’t need two and someone else desperately needs one”.
In the Guy’s clinic we see a huge variety of patients from different backgrounds, nationalities and circumstances. I can never predict what the next assessment might bring. My role as an Independent Assessor is never routine and I really enjoy meeting the donors and recipients and hearing their individual stories.
It’s very humbling to learn the challenges that kidney patients face and the courage of both those living with kidney failure and the donors who are preparing to give up one of their kidneys to help.
It’s a privilege to be able to play a small part in helping kidney transplants transform lives. I don’t get to follow up those I see or know the outcome, but I really hope that little boy got his new kidney and is eating lots of cheese sandwiches. And going swimming.
No comments