Jonah gets a new kidney

By AINSLEY THOMSON

Jonah Lomu is recovering in Auckland City Hospital after a kidney transplant.

The All Black legend had the operation on Tuesday.

His donor, who wants to remain anonymous, is also doing well.

Lomu, 29, has had the rare and debilitating kidney disorder nephrotic syndrome for 10 years, and has been receiving dialysis almost every day since last year.

The operation was being kept secret until the Herald approached Lomu's wife, Fiona. A statement was then released in which the player's doctor, John Mayhew, said the operation had gone well, but it was too early to comment further.

"We do not expect to be in a position to comment on the success of the transplant for at least three months."

The donor was reported to be resting and in good spirits.

"Typically donors are not identified in transplants," Dr Mayhew said. "We respect this, and will do all we can to ensure the donor's privacy."

Dr Mayhew said he saw Lomu after the operation and had spoken to him yesterday.

He was "as well as expected" after a four- to five-hour operation.

Fiona Lomu was tired after going without sleep for a few nights.

Dr Mayhew said the operation had been planned for a few months. It had not been done because of any deterioration in Lomu's condition.

With a new kidney, Lomu might play rugby again, he said. "Jonah's always amazed me with the things he's been able to do and he's played rugby on virtually no kidneys for a long period of time. The surgeons definitely haven't ruled it out.

"He needs to recover fully and then take a large, quick look at life and decide what his goals have to be. But Jonah's certainly been on record saying he wants to play rugby again and that's a possibility."

The surgery was so secret that close friends Eric Rush and Joeli Vidiri had not heard that Lomu had had the transplant. "That's awesome news," Rush said. "My heart goes out to the person who donated it."

Last night, the Auckland District Health Board warned media organisations not to attempt any interviews at the hospital, saying any representatives found on its premises without clearance would be removed and further co-operation with their organisations withdrawn.

Since February, when it was revealed that Lomu needed a kidney transplant because of nerve damage to his lower legs from dialysis, speculation of the impending transplant and his ill health has been rife.

In April, Lomu posted a message on his website to reassure fans that he had not died. In June, he was reported in the Sunday Star-Times as saying a close friend was having final tests to see if his kidney was suitable. He then denied the report, saying several "critical factors" had to be confirmed.

Lomu was told of the possibility of kidney failure just before the 1995 World Cup, but went on to play nearly nine years of top-level rugby, scoring 37 tries in 63 tests between 1994 and 2002.

In April last year, his health deteriorated and he had to quit his Super 12 place with the Hurricanes.

By November he could hardly walk and was on dialysis for up to 10 hours a day, ruining any hopes of playing in his third World Cup.

In late March, Lomu went on the waiting list for a kidney. A month later, Dr Mayhew said his condition was deteriorating and could be fatal if a suitable donor was not found.

The average waiting time for a kidney transplant is about 2 1/2 years.

About a third of patients find their own donor.

Last year 65 kidney transplants were performed at Auckland City Hospital, 23 of those from live donors.

Nephrotic syndrome is not a disease but a number of symptoms, characterised by the leakage of protein, mainly through the urine.

In his book Jonah; My Story, published this year the big winger talked of the onset of his kidney disease.

"Just my luck," he said. "It seems that during dialysis some proteins in my blood are not being properly metabolised or cleaned out. These proteins are eating away at the myelin sheaths around the nerves - nerves in my legs that send and receive messages to my brain.

"The doctors say the condition is dangerous. It can lead to paralysis."

The prologue to Jonah; My Story is dated February this year.

In it, Lomu said the need for a transplant had become critical, and his future in rugby "obviously remains uncertain".

"If a kidney can be found ... if I can be restored to full health, then I'll give rugby another shot.

"I know they're big ifs but the game is still my life."

From surgery to a new life

A kidney transplant is a big operation for donor and recipient, but advances in surgical techniques and more effective anti-rejection drugs mean only a short stay in hospital and the chance of a near-normal life.

Professor John Morton, a former surgeon in charge of kidney transplants at Christchurch Hospital, said surgical teams were assigned to the donor and the recipient.

One of the donor's kidneys was disconnected through "keyhole" surgery and a small incision was made down the midline of the lower abdomen, below the navel, to remove it. The kidney, about the size of a person's palm, was cooled to 4C to ensure it was not damaged and packed in sterile bags filled with ice.

The recipient's kidneys would not be removed unless they were infected or causing other problems.

The new kidney was placed in the lower abdomen, just above the groin and close to the bladder.

Professor Morton said the surgery took five or six hours, and the new kidney would start working immediately. The recipient was likely to be in hospital for three to five days, and would have to make daily visits until anti-rejection drugs were stabilised. Recipients had to take the drugs for the rest of their life.

The risk to the donor of dying from surgery was "absolutely remote" but he or she needed to be aware of other risks such as wound infection and blood clots, he said.

The donor would probably need to take four to six weeks off work.

To be a living donor the person must be in normal health, have two normal kidneys and no history of serious disease.

Potential donors went through a battery of tests to ensure their blood and tissue type were compatible, but advances in anti-rejection drugs meant tissue compatibility was not as vital as it once was.

Donors needed to understand the procedure and make an informed choice. There must be no pressure to donate.

Professor Morton said a live donor transplant tended to do better than a cadaver transplant in the long term.

"A good kidney transplant returns a person's quality of life to very near to normal."

He said it might be possible for a fit transplant recipient to run a marathon, but it would be a "big ask" to return to playing All Black rugby.

"The kidney would be vulnerable to trauma in the lower abdomen, where it could get kicked."

In March, Professor Stephen Munn, director of Auckland City Hospital's liver transplant unit, said in relation to Jonah Lomu it could be possible to place the kidney higher up under the ribs. Figures for 2002 show 117 kidney transplants were carried out in New Zealand. Of those, 48 came from live donors and 69 from cadaver donors.

Carmel Gregan-Ford, education manager for the New Zealand Kidney Foundation, said it received about 10 to 12 calls a month from people interested in donating a kidney.

Some were friends or family of people needing a transplant but an increasing number were altruistic donations.

At any one time about 350 people are waiting for a kidney transplant.

Dialysis costs between $35,000 and $55,000 a year and a kidney transplant about $35,000.

Professor Morton had concerns about people returning to contact sports. He knew of women who had returned to horse riding "but I feel a bit anxious about it".

He advised donors to give a kidney to a relative or friend only if they were confident the person was going to look after it. That meant taking the anti-rejection drugs.

"Also at the back of my mind is I wouldn't give it to someone who is going to put it at risk by playing rugby either."