Failed kidney transplant... now consultants are at odds over decision to operate
Two senior doctors have clashed over who made the decision to go ahead with a kidney transplant on a young boy who later died, an inquiry has heard.
Four-year-old Adam Strain never recovered from the failed operation — carried out at the Royal Belfast Hospital for Sick Children (RBHSC) on November 27, 1995 — and died the next day.
His death is one of five which are being examined by an independent public inquiry into hyponatraemia-related deaths of children in Northern Ireland hospitals.
In the first day of oral evidence, the inquiry heard from Professor Maurice Savage — who was a consultant paediatric nephrologist responsible for the overall care and treatment of Adam.
Prof Savage, who established Northern Ireland’s paediatric renal transplant service, expressed surprise at a claim by the transplant surgeon, Patrick Keane, that he was not involved in the decision to operate on Adam.
In a witness statement to the inquiry, Mr Keane said he had no involvement or input in the decision that the donor kidney was a match for Adam or to accept the organ.
Prof Savage told the inquiry: “I've read this statement before and that surprised me because it would seem to me that it would be very strange that I would phone a transplant surgeon and not tell him everything I knew.”
He made the comments as he outlined the procedures followed at the time of Adam’s surgery when a kidney became available.
Prof Savage explained that when an offer of a kidney was received, he would speak to the transplant surgeon to ensure they were happy to proceed and ensure there was a theatre, anaesthetist and paediatric intensive care bed available.
The patient would then be brought to hospital for tests and to prepare for the surgery.
Senior counsel for the inquiry Monye Anyadike-Danes QC asked Prof Savage whether the transplant surgeon would be involved in the decision to go ahead.
He replied: “I wouldn't obviously have proceeded if the surgeon had any concerns.”
Ms Anyadike-Danes later asked him: “Ultimately, which is the consultant who you think has the responsibility of making the final decision as to whether we should accept any donor kidney?” Prof Savage replied: Well, it's probably me, but if the surgeon was to say to me, ‘I am not happy with the anatomy of this kidney’, I would not take it.
“So it's not something that's made by one person. That's a mutual decision made by both the surgeon and myself.”
The inquiry was also told the kidney was removed from the donor in the early hours of the morning of November 26 and the transplant was originally scheduled for 2am on November 27.
However, Prof Savage said the anaesthetist, Dr Robert Taylor, and Mr Keane decided to delay the start of the operation until the following morning to allow them to get some rest first. The inquiry has already heard evidence experts believe the donor kidney was dead before the operation.
Adam Strain was placed on the waiting list for a kidney transplant on November 24, 1994. An offer of a kidney for Adam was made on November 26 the following year. He received a kidney from a 16-year-old donor. An inquest into Adam’s death identified hyponatraemia contributed to his death. Hyponatraemia is a condition where there is too much fluid in the body and the inquiry is looking at the fluid management of Adam prior to and during his transplant surgery.