Health: After the agony, the freedom: Kidney recipient Ted Harrison joins the debate on transplant problems

IT IS not much fun having a kidney transplant. There is one chance in five the operation will fail, but after four and a half years on dialysis I thought it a chance worth taking. There are moments of sheer agony, but at the end of it all, for the 80 per cent of recipients whose new kidneys work, life is transformed.

All transplant patients must take drugs to counter possible rejection of the graft, so each morning and evening there is a tot of medicine and a handful of pills. Some cause side-effects - patients may gain weight or grow extra hair - but the inconvenience is minimal compared with day after day of dialysis and dieting.

Two weeks ago an article on this page described the feelings of a patient after her transplant. She had waited two years for a new kidney, which worked immediately. But many people wait five years or more, then wait weeks for the kidney to start working.

Those whose kidneys work well after transplants are mindful of the 20 per cent whose kidneys are rejected and who have to return to dialysis. We have little sympathy with those who complain about minor inconveniences. Avoiding public places to prevent infection is a wise precaution in the early months but need not become a way of life. A successful transplant gives a new freedom and an amazing sense of wellbeing.

As well as having had a transplant, I have also watched one being done. I have seen a kidney being attached to blood vessels and watched it swell, change colour and return to active life. It is spectacular and miraculous.

But there is a strong case for arguing that the medics underestimate the psychological aspects of the procedure. A successful transplant is not just a piece of human plumbing. A handful of patients have difficulty in returning to 'normal' life, having come to depend on the support network available when on dialysis.

The major psychological adjustments most transplant patients face are of three kinds. First, the full implications of the procedure are seldom outlined in advance. The first days after the operation come as a bit of a shock, getting used to a catheter in the bladder, frequent biopsies and investigations and hospital routine.

Second, little is done to help patients through the trying days or weeks of waiting for a kidney to work. It seems an eternity, and it is no comfort to be told simply that 'some take a long time'.

Third, patients from time to time wonder about their donors. Except in the tiny minority of cases when the donor is a living relative, donors are not identified by name, and there is no opportunity to offer thanks directly. Some patients feel guilty that their new life is the result of the death of another. They examine their own worth, wondering why they were chosen to live while the donor died. Such thoughts lead to deep questions about life and death.

Some patients find it helps to write an anonymous letter, which is passed to the donor family through the transplant co-ordinator. Sometimes the replies are very touching.

Recipients need to understand their feelings about donors. In some parts of Britain renal units arrange church services at which donors are remembered and the recipients give thanks. The staff and the surgeons are present, too, and there is a great family atmosphere.

I do not know who my donor was, but I can appreciate how a person who has received a child's kidney will dwell on the special grief involved in that child's death, and find it particularly difficult to cope with these feelings.