Early Career Researchers

Dr Sunil Daga is a Consultant Nephrologist at Leeds Teaching Hospitals

As a child, both of Sunil’s aunts had kidney failure. Both had living kidney transplants. It set him on his life path.

“The idea that you can take a kidney out of a living person and put it into another, and they can both live healthily, grabbed my imagination. I could see the difference in quality of life. At that point, I didn’t even think I’d be a doctor, or I’d be specialising in kidney transplantation.”

Sunil says demand for dialysis will increase 400% in the next ten years.

“It's shocking. A year ago, Kidney Research UK published that kidney disease is a public health emergency. In Leeds, every other day an individual is starting dialysis treatment. In terms of resources, we are already struggling. Kidney disease and dialysis is right at the top of the agenda for Leeds Teaching Hospital, and the wider West Yorkshire footprint.”

Dialysis, Sunil says, is costly – to the taxpayer (it costs up to £50,000 per year), to the environment (dialysis uses 18,000 litres of purified water) and to patients, who have to attend hospital for four to six hour a day three times a day affecting their productivity and thus huge economic cost to the society.

“Dialysis is an important lifesaving treatment, but if we can avoid or if we can minimise that it’s an advantage for both the patients, the family, but also the wider healthcare system.”

Living kidney donor transplants offer the best outcomes, but there is a shortage of donors; 5000 are on the waiting list and can wait up to three and a half years for a deceased donor transplant.

“The best treatment pathway for patients with kidney disease is to detect the kidney disease is early, you can prevent the progression by medicine optimisation. But if you can't, then you need to prepare them for a kidney transplant. That is the ideal pathway, but I'm afraid only 5 to 10% of patients would experience that across the UK. What that means is, a lot of our patients aren't picked up early, aren't referred to renal services early, and then even when they are, we're not actually able to translate that opportunity into kidney transplantation. Often people think the kidney transplantation is the last resort, in fact it should be the first choice to maintain good health and improve life expectancy. So, I'm trying hard at different pinpoints on that pathway to look at where we can improve things.”

Leeds Hospitals Charity funded the second stage of his research into the barriers to living kidney donation.

Sunil says those of South Asian or Black ethnicity are five to ten times at higher risk of kidney disease.

Equity is a key challenge, with studies showing male, white, middle-class patients and individuals with higher education and income are more likely to get a living kidney donor. Unlike other clinical decisions, living kidney transplants depend on family or friends to donate.

“If you're a woman, if you're ethnic minority, if you're not educated, if you're not well off financially, you're going to wait for a transplant from the deceased waiting list. We’re working in one of the most deprived areas, with a lot of ethnic minorities, many with poor proficiency in English and poor health literacy.”

The research led by him focussed on being inclusive to diverse, underserved patients (a third of participant did not speak fluently in English and a third were from lower socioeconomic backgrounds), and explored what influences decisions to donate, how to navigate concerns around living donation, and how to put a system in place to support donations in a timely way to reduce health inequality. This was a collaborative work between Leeds Teaching Hospitals, Leeds Institute of Health Science at University of Leeds (Dr Shenaz Ahmed and Dr Anna Winterbottom) and Bradford Teaching Hospital NHS Trust (Dr John Stoves), undertaken by research student Dr Ahmed Ahmed.

“The best way to describe equity is if you give a child, a disabled person, a man, and a woman, an adult male bicycle, you can't expect the child or disabled person to ride it. You would want to adapt the bicycle. And that is what individual care is, and that's where we're focusing in our research - can we individualise our model and care, so we can get everybody from point A to point B irrespective of whether they are disabled, a child, a woman, or a man.”

Sunil has positioned Leeds as a global leader in equity and living kidney donation as a result of the research and the findings of this study is starting to bring change in Leeds and beyond.

Phase one of the research interviewed health professionals (from Renal units at Leeds and Bradford) on their views around supporting diverse groups, resulting in six recommendations for any transplant centres in the UK, and a published paper in Transplant International.

“We're very proud because that research was presented both nationally and internationally at the European Society of Transplantation, and the British Transplant Society.”

The next stage was focussed on patient interviews with ‘inclusive sampling’ to gain diverse perspectives around different outcomes of the patient journey.

“We wanted to have 50% of these as women, because women are underrepresented across research and also in the kidney world. We wanted a third to be individuals who don't speak English - we managed that through interpreter services and colleagues like myself who could speak many languages. We also wanted a third of individuals who are uneducated, who are from lower socioeconomic deprivation.”

Sunil says they wanted the research to have changes on the ground, not just appear as an academic paper, so the team engaged clinicians to continue to gain insights. The findings were presented in the national Living Kidney Donation network workshop where colleagues from all the transplant and renal centres undertook joint learning.

The next stage is a patient conference to present the research data and share learning amongst patients and public group.

“This research is going to allow Leeds to establish the decisional needs of the diverse community around living kidney transplantation and ultimately increasing the number of such lifesaving and transforming treatment for all.”

The team will be sharing learnings from this study and implementing a system in transplant centres/hospitals across the UK to support patient decision making around LDKT, through these lived experiences.

He says: "None of this would have been possible without all the work that has gone on the last three years, supported by Leeds Hospitals Charity, so I'm very grateful to the charity."

Sunil advises multiple charities in the field of kidney disease and equity, particularly for the South Asian communities.

“My own ambition would be to develop Leeds as a centre that is going to drive this research further and improve access to life saving transplantation in an equitable way.”

All photo credits: Ruby Lee
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