15 minutes with . . .
A kidney transplant surgeon
Authors: Sally Carter
Publication date: 12 Mar 2011
Sally Carter talked to Andrew Ready, who performed Ghana’s first organ transplantation
Name: Andrew Ready
Position: Kidney surgeon, Queen Elizabeth Hospital, Birmingham
Biography: Qualified in medicine at the University of Birmingham before training in general, endocrine, and transplant surgery. He also studied the immunology of transplantation before undertaking research at Stanford University, California. He is a cofounder and medical director of a charity called Transplant Links ( [Link] ) that works in developing countries to help set up, support, and maintain transplant programmes.
Why did you choose surgery?
I can’t recall wanting to do anything else. It was something that I knew I had to do. I think that is the case for many surgeons. I do remember rushing out and buying a copy of Life magazine after Christian Barnard did the first heart transplantation. When I saw the centre spread of a colour photograph of the heart in the surgeon’s hands I knew I had to do surgery. I went to medical school wanting to be a cardiac surgeon. After I had qualified and done a cardiac surgery house job, though, I found that I didn’t enjoy it and decided to do general surgery. But, ultimately, I came back to transplantation. I think the appeal of surgery is that you can make life changing and life saving differences to people by reaching inside them yourself and not through the intermediary of a tablet or medicine. That’s a powerful thing and, I suppose, all about taking control. The need to have a large degree of control is probably another characteristic of most surgeons.
How did you become involved with Transplant Links?
My other passion in life has always been travel. When I was invited to go to Trinidad in 2006 to help with their transplant programme, I jumped at the opportunity. After I came back I was approached by Jennie Jewitt-Harris, a friend and doctor. She was creating a charity to help develop transplantation in the developing world and wondered if I would help. Again, I jumped at the chance, and became Transplant Links’ medical director. One of my nephrology colleagues, Jo Adu, is Ghanaian and he suggested Ghana as a first project. We have since grown our links with Ghana and Trinidad and worked in Nigeria, Nepal, and Egypt. We hope to visit Bangladesh and Jamaica this year.
What has been your proudest moment working with this charity?
It was when I did the first ever organ transplantation in Ghana. When the kidney had been transplanted and re-perfused with the recipient’s blood, urine started to pour from the ureter. The operating theatre was full of observers, and as I demonstrated the urine production they burst into applause and did so every time a spurt of urine emerged from the ureter. I think they saw this as symbolic of a step forward in the level of healthcare available, and I felt some of the excitement that the first transplant surgeons must have felt. That was three years ago, and the recipient of that transplant is back at college and enjoying life.
What has been your most challenging operation?
Laparoscopic donor nephrectomy—I had some excellent laparoscopic exposure when I was training and have always enjoyed the challenge. Laparoscopic live kidney donor surgery has the additional challenges of removing an organ in a way that it maintains its structure so that it can be transplanted, with a nearly 100% success rate, into another person. Even more difficult is the fact that the donor has nothing physically wrong with them and is having the operation only for the benefit of someone else. So there’s no margin for error. Ultimately the weight of the emotional investment on the part of patients and staff in these operations is on the surgeon’s shoulders.
What single thing would improve the transplantation rate in the UK?
Probably no single factor can achieve this objective. We have many routes to organ donation, some from living and some from deceased donors. It is unlikely that some new legislation or technique will increase the availability of organs to the point where the imbalance between supply and demand disappears. On that presumption, we should work to maximise all the current means through which donation occurs and to recognise that the supply of organs might never catch up with the demand for organs, particularly kidneys.
What single thing would improve the transplantation rate in the other countries?
In the developing world the single greatest factor would be the recognition, by politicians and other leaders, of the problem of renal failure. It is currently an “unknown epidemic” that is killing huge numbers of people worldwide. Recognition is the first step to setting up treatment programmes. Governments are reluctant to get involved, however, because dialysis and transplantation are so expensive.
What advice would you give to any medical students who are thinking of becoming surgeons?
Ask yourself if you really want to do it. If there is any question in your mind then don’t go in that direction. It’s a pretty tough business, and if you’re not in 100%, it won’t make you happy. If you really can’t contemplate the idea of doing something else, then go for it and recognise that being persistent pays off. Most importantly, don’t forget to enjoy the journey towards your ultimate career destination.
Competing interests: None declared.
From Student BMJ
Sally Carter technical editor