Although it is a dark day when you lose a loved one, with organ donation, there is some solace.
Finding hope in tragedy
When she was just 12 years old, Dr. Tammy Keough-Ryan suffered what can only be described as a traumatic experience.
“I’m a motor vehicle accident survivor. I woke up five days after a car crash with a fractured skull and no memory of the accident. Tragically, my 21-year-old cousin had been killed in the seat next to me.”
It was Dr. Keough-Ryan’s first brush with death or the loss of a loved one, but not her last. Three years later, she lost her 17-year-old brother, who was a passenger in a car hit by a drunk driver. She survived meningococcal meningitis at age 17. At 19, she lost her father to bowel cancer.
When she was in medical school, a close friend’s brother died of a brain aneurysm. He was a multi-organ donor. “I remember his widow speaking to my medical school class about how hard it was to lose him, but the silver lining was that he lived on through organ donation,” she said. “That heroic act really impressed me. Having been through my own dark days, I realized that it was possible to bring goodness out of tragic experiences.”
As a nephrologist and the medical director of the Atlantic kidney transplantation program for the Multi-Organ Transplant Program at Nova Scotia Health, Dr. Keough-Ryan’s work has been transplant-focused since she completed extra clinical fellowship training in transplant nephrology. She works closely with patients with end-stage renal disease who receive the gift of life through organ donation.
The Atlantic kidney transplant program is the only multi-province transplantation program in Canada, which poses unique challenges for Dr. Keough-Ryan and her team. Given that there are four provincial ministries of health in Atlantic Canada, each with their own organ donors and recipients, each transplantation involves considerable coordination.
“There are multiple physician and allied health team members discussing, collaborating, deciding and organizing steps that bring together organs and recipients,” Dr. Keough-Ryan said. “It’s complex, time-sensitive, and fast-paced but fascinating and so rewarding. Being matched with an organ often makes a patient feel like they have won the lottery.”
The donor offer starts with a call from an organ donor coordinator and doctor. The kidney donor is carefully screened and the information provided to a nephrologist, who makes a final decision after comprehensive discussions with surgical and other medical colleagues to determine whether the organ is acceptable. A computerized matching algorithm is run and when a match is determined, a nephrologist such as Dr. Keough-Ryan will review the patient chart with a recipient coordinator and surgeon to ensure which paired match or matches can proceed.
“We’re typically conducting a rapid medical review with the referring centre as we are trying to organize the OR time and the travel arrangements are being coordinated,” she explained. “Ensuring the kidney is transplanted in a timely fashion is our goal.”
Although Dr. Keough-Ryan is the medical director for kidney transplantation, every procedure is a huge team effort. She is supported by other physicians, plus nurses, a pharmacist, a psychologist, social workers and administrative staff. “Organ transplant is an interdisciplinary field; I’ve had the opportunity to work with so many champions. Our team’s working dynamic is phenomenal.”
Dr. Keough-Ryan says the team concept is even broader than that. “There are the heroes who make the decision to donate their organs, their families, the people who take care of the donated organ, and the organ recipient.”
The relationships Dr. Keough-Ryan has built with many of her patients – some spanning more than two decades – are enduring. “The relationships with the patients are often so long that they feel like they are part of our families,” she said.
Family is important to Dr. Keough-Ryan. She is the fifth of seven children and she attributes her success to her parents. “I dreamed of becoming a doctor but didn’t think I could achieve it. My parents had not gone to university, so it felt like an unattainable goal. But my mother instilled in me the importance of work ethic and reading, and my father taught me that hard work would pay off. That gave me confidence to study sciences in high school and then pursue pharmacy.”
Her 19-year-old son, Derek, is in Dalhousie’s medical sciences program and hopes to pursue a career in medicine, following in Dr. Keough-Ryan’s footsteps.
Dr. Keough-Ryan worked as a community and then a hospital pharmacist, but her dream of being a doctor persisted. “I became a director of pharmacy at St. Clare’s Hospital in St. John’s, N.L., at 24, and I worked there for three years as director,” said Dr. Keough-Ryan. “I continued to work in pharmacy part-time through medical school.”
This determination has served her well. She values the lessons learned early in life and the perspective they bring to her work today. She says her former career as a pharmacist was a valuable background. “Kidney disease has ramifications on choice and dosing of medications. Immunosuppressant medications are fundamental to the retention of kidney transplants, as are other medications to treat comorbid diseases that can impact the health of the patient and the graft.”
With Nova Scotia’s new opt-out Human Organ and Tissue Donation Act – the first in North America – now in place, Dr. Keough-Ryan is optimistic about its impact on transplantation for her patients. “This is the result of dedicated collaborative work and I’m happy to be a part of it.”
She hopes it will lead to an enhanced understanding of the gift a donor organ can be for someone in need. “Although it is a dark day when you lose a loved one, organ donation gives some comfort or consolation in the time of distress. I see the changes that donations make to my patients’ lives every day. I have no doubt there would have been solace for my family if my cousin and brother had been organ donors.”