Series filmed over a year, taking a look at the health service in Northern Ireland. Jonathan Spiers donates his kidney to save the life of his brother William.
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I mean, you always hear about people's families and you don't
really think about it until it comes to your own door.
To have been told that you could survive and get new life
from a new kidney was the only hope I was living on.
Truly, our donors are our heroes.
They put themselves on the line for the love of another human being.
Just got a call from ICU. Told us that they might have a body.
It's hard, you know, moving a child or baby.
They haven't really lived a life.
So, this gentleman's coming with a wound to the back of his head
and a sore-looking eye but we don't know why.
He doesn't speak any English at all.
The first two nights, I cried myself to sleep.
My husband was murdered during the Troubles,
so I've sort of never got over that, like.
There are times when I would go away and I would weep,
because, yeah, some of the things are very difficult.
We've spent a year looking under the skin of the health service,
focusing on the large team of people
who dedicate their lives to saving ours.
Around 1,700 people in Northern Ireland
are living with end-stage renal failure.
800 patients are on dialysis.
Last year, the Belfast team performed
a record-breaking 115 kidney transplants.
We're now number one in the world
and this makes the whole unit feel immensely proud.
I'm William Spiers.
I'm from Killyleagh.
I discovered that I took a cyst in my belly button.
The doctors rang me to say they'd found something in my blood.
They discovered that my kidney function was only working at 15%.
So whenever they scanned my kidneys, they could hardly see them at first,
because they were that small and they'd shrivelled up.
It's difficult for me to convey how dangerous kidney failure is.
Your life expectancy is halved.
It's got a worse survival than most cancers.
My brother Jonny here is going to give me his kidney on Wednesday,
so if all goes well, it'll be life-changing for me.
Even a blood test, I would get worried about going to the hospital
for that and that's only a simple thing,
so, nervous but still excited at the same time.
Hopefully it'll not be too bad for me.
It'll be nothing compared to what my brother has to go through anyway.
So, anybody in the same situation would do it, so they would.
No, but he's very brave, too.
He's a hard nut, like.
You always hear of it in other people's families
and you don't really think about it until it comes to your own door.
When it does, it definitely hits you, like, so it does.
It hits everybody.
Dialysis can only work for so long, for some people,
and, you know, whenever I was told all this, it didn't really...
You know, it was really hard to take in.
It does make you a wee bit emotional,
so it does.
You know, to have been told that you could survive and
get new life from a new kidney was the only hope I was living on.
It was just the relief that he got a kidney,
so it was. It just happened to be mine.
I'd have been happy if it had have been my sister or my brother's
but it just turned out that mine was the best match available.
At the Royal Belfast Hospital For Sick Children,
paediatric neurodisability consultant Claire Lundy
and occupational therapist Julia Maskeray
have an appointment with three-year-old Aoife.
Aoife's case would be fairly typical of a child presenting
with hemiplegia which have resulted in a problem
with moving the right arm.
We need our marbles.
We need to open our bottle
and pour them into our saucepan to make our soup.
You do it. Aoife do it.
Good girl. So, holding.
One hand to hold.
Clever, clever girl.
Today, Julia will focus on Aoife's right hand.
Oh, Mummy, wait till you see.
The assessment is play based but it really does assess how effectively
a child uses their two hands through play.
What about this hand?
Can you put a bracelet on this hand?
One, two. Or will we tidy up?
What do you think? Do you want it on?
They are actually trying to elicit certain behaviours with the upper
limb and it can be to see whether they can actually grasp
and stabilise an object, so it does look like I'm playing but we
are actually looking to see is what it is that's
limiting that child's function.
Aoife did really well there, didn't she?
-She did, didn't she?
-You're a wee star, aren't you?
One of the things that we noticed is
that her grip is limited by her thumb being stuck across the hand.
One of the treatments that can be very helpful is using botulinum toxin,
a day case procedure up in Musgrave Park.
And the aim of the botulinum treatment is to improve her grip
and hopefully the functional use of her right hand.
The botulinum toxin gives us a window of opportunity but what
actually has to come is a lot of activity.
It is the activity that creates the change.
-Good girl. Well done.
In Craigavon, hospital porter Paul Anderson starts his shift.
A typical day of our porter is transfers from ward to ward.
Blood units. They bring all the linen up to the wards.
Then there's security too.
If any people's kicking off, or anything, we just go up
and try to calm them down and put them back to bed.
Usually on the weekends, it'll all kick-off.
Giving abuse out all the time to nurses, so they phone us.
Sometimes we see it on the camera before the nurse even says.
You can even tell who's coming to the door,
who's going to kick off, the state of them. They're drunk.
Part of Paul's job is looking after the car park.
I'm just out here studying cars,
cars that are not supposed to be parked here.
It's not right on disabled people. We have to go out and put these
stickers on them just to warn them to not park there again.
I had to sticker a man's car there, so I did.
It was in a disabled spot, so I had to put a sticker on it.
They're a bit hard to get off, so they are, so I don't like doing it,
like, but it has to be done.
Maybe it'll give him a hint not to park there again.
The day has finally arrived for Jonathan
to donate his kidney to his brother William.
There's nothing routine about living donor surgery.
The stakes are so high in terms of outcomes.
When these things go well, it's fantastic, but
when things go wrong, you really feel it.
Reality is just kicking in for William and his girlfriend Joanna.
There's no turning back now, so there's not.
The nerves is kicking in...
..but, sure, it has to be done.
Yeah, I'm really excited that he's finally getting a kidney.
Like, people don't really realise how much it changes your life being
on dialysis. I feel like I'm going to cry now talking about it...
It's been a tough year, like, for us.
So it has.
Very nervous. I'll be happy when it's over and he's back up here.
The Spiers family have had their fair share of heartache this year.
We're a very close family, like,
especially this year has brought us all together, real close.
It'll be strange now whenever I get home, so it will,
because I have two kids at home.
They're staying with their granny, so they're all excited about that.
I had three kids but one of them unfortunately passed away last year.
Kayla passed away at the end of August.
She lived for four days and...
It just wasn't meant to be.
Truly, our donors are our heroes, they really are.
They put themselves on the line for the love of another human being.
Whether it's their brother, whether it's their sister, mother, father,
they've put themselves at risk
and the risks are significant.
It's definitely a good thing he's doing, like.
I'll see you later on. Right, Vanessa.
At the A&E in the Royal,
triage nurse Jane Wilson has an interesting day ahead.
So, this gentleman's come in with a wound to the back of his head and a
sore-looking eye but we don't know why.
He doesn't speak any English at all. Could you interpret for me, please?
Could you ask this gentleman what's brought him up to A&E?
IN OWN LANGUAGE:
A fall? When did that happen?
Did he tell you anything about the fall?
It's really, really important that I know, was he knocked out or not?
I need you to ask him, did he get knocked out?
Was he unconscious?
I need that answer. And I also need to know why is he on warfarin?
Here you go.
-Mr Lin produces a hospital letter.
I think, roughly, he fell this morning and he doesn't know why.
So, he just woke up on the floor so we'll have to just treat it like it
was some sort of heart collapse or something severe and work back.
After consulting with the interpreting service,
it appears that Mr Lin lost consciousness
whilst sitting on the toilet.
Apparently he fell, resulting in a head injury.
Further tests are now needed to rule out anything more sinister
than just a cut to his head.
In Belfast City Hospital,
Mr Tim Brown and his team prepare donor Jonathan for his surgery.
All William can do now is wait.
Mr Brown will perform keyhole surgery to remove Jonathan's kidney.
He begins by making two incisions in Jonathan's side and inserting a
camera to help him navigate his way through
the vital organs to reach the kidney.
So, we just put some gas into the tummy to make sure that we can see
what's what, so that it gives us some room to operate.
And that's hopefully what we'll be able to use to take this kidney out,
so, what we've got to do is move a few things out of the way
to get to the kidney. We've got the colon here
which we're going to have to move out of the way.
It's got natural adhesions to the tummy wall,
which we'll have to take down first of all.
I'm using an instrument that cuts with ultrasound,
so what it does, it cuts and seals any blood vessels,
because it's nice not to operate with any blood around.
After two and a half hours, Jonathan's kidney is removed.
We're going to disconnect the kidney from the blood supply.
Just come back.
So, this bit is the time-crucial bit.
We want to try to minimise the time at all because when the kidney
is warm and not getting a blood supply,
then that's when the damage to the tissue is done.
A larger cavity is needed to retrieve the kidney.
So the problem is we've made a hole in the lining of the tummy in order
to get the bag in but we need to still keep operating with
the gas inside the tummy,
so this is what this elaborate sort of situation is about now.
Gas on, please.
Jonathan's kidney is now ready for retrieval.
And then what we do is we put the kidney in the bag.
There we go. Scoop it up.
OK. Top lights on, please.
Very good. And that goes over to get nice perfusion.
When the kidney comes out,
we need to make sure that all the blood vessels are suitable for
transplantation, so there's a bit of tidying up on the back bench when
the blood is flushed out of the kidney
and it's cooled down to stop the metabolism of the kidney
in order to preserve it while it's not being perfused with blood.
So, it looks like a nice kidney. Very pleased with that.
Just give it a bit of a tidy up.
Make it look pretty. Very, very pleased with that.
In Craigavon, porters Paul and Raymond are on the night shift.
Tonight, they face one of the tougher parts of the job.
Dealing with death is a big part of hospital life.
You soon get used to it, like, it's just part of the job.
You don't even think about it after a while.
Sometimes three or four a day, so...
So it's a right few over the year, like.
When I first started,
if I had to move the body, it was tight enough.
I didn't really like doing them.
It's hard. Especially, I've got a child and all, so it's hard,
you know, moving a child or a baby or anybody under a certain age.
I've a child myself, like, so I don't really like doing them.
Like Raymond was saying, young ones are hard to do,
but you soon get used to it. It's part of the job.
You don't even think about it after a while.
You just get on with it and that's it, really.
Jonathan's surgery is over and he's taken to recovery.
Are you feeling all right?
Just tired. A wee bit of pain but nothing...
I've felt worse, like.
That was a very long day, waiting for him.
It's now William's turn for surgery.
So this morning's operation was keyhole.
This is definitely not a keyhole operation.
This'll be what we call an open operation.
Mr Brown begins by opening an area of tissue
just above William's groin.
The new kidney is placed in this area
and connected to the main artery in William's leg.
-So can you see in the screen yet?
Yeah, so that's the blood supply to the leg.
That's the external iliac artery.
So what we've got to do is prepare these vessels to accept the kidney,
so that means getting rid of some of the tissue surrounding them.
Yeah, this way.
Right, so now we've got the kidney
that Jonathan so kindly donated this morning.
So we got the ureter, we've got the artery here sitting behind them.
So what we've got to do is join, put the ureter onto the bladder.
OK, so what we want to do now, see how he wants to sit.
That looks like he wants to sit there very nicely.
In order to get the kidney connected,
we need to make a hole in the vein
and to do that, we need to get control of it,
so we've closed off the vein on one side and to the other.
Can I get a knife, please? Thank you.
So now we're going to make a hole in this vein and hope that
the instrument has connected it properly, which it hasn't.
Suddenly, the clamp fails but within seconds,
he has the bleed under control.
The team can now transplant Jonathan's kidney into William.
The moment of truth is when the grey kidney plumps up and turns pink.
So you can see, it's all white, so what we're going to do
is let the artery in and that'll go pink,
hopefully, and swell up.
That's exactly what we want to see.
and then let the vein in and that's the kidney back to life again.
So what we're looking for now is the ureter.
I want to see clear liquid coming out of here, so we'll see...
Oh, and there we go. So the kidney's started to pass water already,
so that's really good.
The transplant is almost complete.
So you can see the artery joined there
onto to the external iliac artery,
a nice pulse and the vein in front of him here
just going on the iliac vein in front of it.
A nice pink kidney and then the ureter's
going in there into the bladder there.
It's been two days since William received Jonathan's kidney.
He's waiting for his creatinine test results
to see how well it's performing.
-Well, William, how's it going?
-All right? Not too bad, thanks.
-Good. Feeling OK?
-Yes, feeling brilliant.
The numbers have come way down so, before we started,
-your creatinine was over 600...
..and today it's 200, so...
-That's very good.
-Over 48 hours, that's superb.
So, great. Yeah, you look fantastic. I'm delighted, really delighted.
-Thanks so much.
-OK, all right, see you later.
A significant decrease in creatinine levels indicates
that the new kidney is functioning as normal.
-Good, all right, so you're feeling OK, not too sore?
-Not too bad.
-Good. Have you been up and around?
-I've been up.
I went for a walk earlier and got washed all by myself.
-Glad it's over.
-Glad it's over, absolutely.
-You and me both.
-You're very welcome. Right, OK.
-See you in a bit.
-Thank you very much.
-All right, OK.
I was sick, yesterday.
It was rough with all the stitching and all that.
Then I felt all right after that, like.
People say he's looking worse than me!
So, I don't know.
But, no, I think he's doing all right, like.
He'll soon recover and the surgeon said he'll be out
in a few days' time and all, so.
Did you get a drop of dinner, did you?
Aye, smoked fish or something.
Are you getting the hell out?
I'll say it's lovely as we're on camera, but it's not really.
-Are you feeling well anyway?
It's good to see him up and about, like.
That's what it was all for, like, so it was.
Having that kidney, that doubles his life expectancy
immediately compared to being on renal dialysis
and he will be able to lead a normal life.
Two months after her assessment, Aoife returns
to Musgrave Park Hospital for her botulinum toxin injection.
Ideally what we'd like to do today is to do two injections,
one in her little thumb to help bring the thumb position out
and help improve...
Just like that, angel, just like that. OK?
Well, that'll be good, won't it, darling?
It's going to help your hand, isn't it?
Well, I just do that with my thumb
with the other thumb, that's why.
Can we do high-fives?
'The medication itself is a very small volume'
and we use very fine needles but children who're old enough
and can tell us, say that some of the injections in the upper limb,
there's a slight sting but that's about it.
For young children, even the process of coming up to hospital
can sometimes cause distress and I think in Aoife's case,
one of the things that bothered her
was actually the jelly that we need to use for ultrasound scanning.
In the end, Dr Lundy decides to give Aoife her injection a bit later
but she's able to give Eva, who's in the next bed, her injection.
Eva has been born with cerebral palsy
affecting her left side.
Her left arm, she has very little use of it at all
and she can't hold anything in it, she's no grasp.
So we're hoping that these injections today can maybe just
loosen her arm up a wee bit and give her a wee bit more use of it.
Who's going to sit beside you of these guys?
-Both of them, OK.
'The families that I work with are just incredible.'
They constantly surprise me with, you know,
their level of commitment to their children.
You're OK, pet, you're all right.
-A little jag, pet.
-It's going to take two seconds.
You are super.
Brilliant. Good girl.
That's a big smile.
'For many families, their children are in daily pain
'and those would be the children that we really try and prioritise
'as best we can'
and I don't know that I could ever do what they do.
So stretch your arm out this way.
In Belfast's Mater Hospital,
Chaplain Rosie Morton begins her rounds.
Being a chaplain is a distinct ministry.
It's different to being in a parish or a church
and it's different because you are part of a team.
There are times when I would go away and I'm not so brave faced,
I would weep, because some of the things are very difficult.
'It's not a role for the faint-hearted.'
Hello, Ann. It's lovely to see you.
-Nice to see you, too.
-Now, I haven't seen you for...
-Since last week.
-It was. Last time I was in a different ward.
The first two nights, I cried myself to sleep,
I couldn't sleep.
-But thank goodness now I can.
'Ann is quite a sad story.'
She has lost touch with some of her family.
-And, Ann, would you like me to say a wee prayer with you?
Well, you could pray for my son who I haven't seen for about 16 years.
-Just that he's fine and I hope he keeps well, you know?
And he's two children, so I don't see them, you know?
And, it's hard to... I know it's a long time ago,
but it's hard to sometimes cope with it, you know?
Do you have any other family?
No, I have two brothers but we don't bother...
And my sister died about a year and a half ago
and I just read that in the paper.
And my husband was murdered during the Troubles, so...
I've sort of never got over that, like.
You've had an awful lot of hard things.
I have but people don't...
-don't realise, you know what I mean?
-Well, will I say a prayer?
Gracious God, we come as we are
because we can do no other than be ourselves.
'Clearly there's been stuff...'
A really difficult number of things in her life.
But today and every day be close to Ann.
-Thank you very much indeed.
-That was lovely.
-Well, it's been good seeing you today.
-It's good seeing you.
-Thank you very much.
It's very humbling, meeting somebody and listening to that.
It's been over three months since
Jonathan donated his kidney to William.
Life has changed dramatically.
Obviously, after the operation it takes a bit of time
for all the healing process and all to take place.
Just waking up and feeling healthy and strong,
you know, being able to eat my steak again, is...
We are a close family, like, but Johnny,
when I look at him now, like, he's definitely...
You know, for him to do that for me was amazing, like,
and I just think the world of my brother.
Well, I'm keeping well now, like!
The first few days was a bit tough.
Well, I wouldn't say tough, just a bit...
I was maybe a bit sicker than I thought I was going to be but just
everyday after that, gradually you could feel yourself getting better.
Now I wouldn't even know I've had the op, whereas for William there,
he's just totally, totally changed.
It's like the difference between night and day.
It makes me feel that it was worth it, so it was.
The wife, she's expecting again now, which is sort of like
a bit of sunshine in the bit of bad weather,
you could call it, that we had.
By receiving that kidney, I would hope that that kidney would last,
on average, at least 25 years
and give William a successful life for 25 years,
and our record in Belfast
for length of graft function is 40 years and still going.
'It feels amazing just to be out and about again
'and enjoying each other's company again
'now we're all fit and well.
'I think people take life for granted, sometimes.
'It is a pretty amazing thing what the doctors
'and all can do for you and I can't be more thankful for it.'
A year looking under the skin of the health service in Northern Ireland, showcasing the large team of staff who dedicate their lives to saving ours.
Jonathan Spiers donates his kidney to save the life of his brother William. The transplant is performed by consultant Tim Brown at Belfast City Hospital.
Porters Raymond and Paul have to deal with moving the body of a patient who has just passed away.
Consultant Claire Lundy and cccupational therapist Julia Maskery treat three-year-old Aoife, who has hemiplegia.
At Belfast's Mater Hospital, chaplain Rosie Morton meets a lady with a tragic backstory.