Professor Donal O’Donoghue was a clinical nephrologist and the first National Clinical Director for Kidney Care for England. A passionate advocate on behalf of people with kidney disease, he became a leading force driving the development of effective nephrology services in the UK and beyond. He tragically died suddenly when still at the height of his professional career.
Donal Joseph O’Donoghue was born in 1956 in Manchester, his father a head teacher and his mother devoted to the upbringing of their two sons. Apart from brief spells working elsewhere in the UK and Europe during his nephrology training, Manchester remained his home and the centre of his professional work. He qualified from the University of Manchester in 1980 with First Class Honours in Physiology in 1977, and MB ChB with Honours in 1980. He trained in internal medicine and nephrology in Manchester, Nottingham, Leicester and Edinburgh. In 1987 he received a research training fellowship to study immune mechanisms in glomerular disease in Manchester, particularly IgA nephropathy, Henoch-Schὂnlein purpura, and ANCA vasculitis. Then in 1989 he was a Medical Research Council Travelling Fellow at Necker Hospital in Paris.
In 1992 Donal was appointed consultant nephrologist at Hope Hospital in Salford, later to be renamed Salford Royal Hospital. This was the only tenured position he ever held, and he was still in clinical practice there at the time of his death.
When he came to Hope Hospital the renal unit was small, understaffed and overstretched. He became clinical director, and with his colleagues he set to work modernising and transforming the service, developing the multi-professional team approach and a patient-focussed culture which became the hallmarks of all his future local, national and international work. The unit’s practice became evidence based and subject to continuous quality improvement by audit, peer review and multi-professional research. Such approaches now seem routine but thirty years ago they were innovative, and not always understood or valued. There had also been a lack of coordinated service development and chronic underinvestment in renal services across the whole of Greater Manchester, illustrated by 50% of those starting renal replacement therapy (RRT) receiving peritoneal dialysis for lack of haemodialysis facilities; patients could not be given the choice of treatment modality. The need for a radical review was accepted by the North West Region, and despite his youthful lack of experience in medical politics, Donal was appointed to chair a Renal Strategy Group which overcame substantial challenges to produce a consensus plan for future provision of renal services through hub and spoke development across Greater Manchester. From 1998-2001 he directed the implementation of this complex plan through change management with service redesign, information technology, human resources, education, research and finances all considered; crucially patients and carers were involved in all phases. This became the Greater Manchester Renal Managed Clinical Network, which he chaired, the first of its kind in the UK.
Donal had found his métier in clinical and organisational leadership, and national opportunities soon followed. In the late 1990s the UK government had proposed a National Service Framework (NSF) for Renal Services, a description of an optimal service against which existing services could be judged and resources sought; he chaired the NSF development through some rocky issues to a successful completion in 2005, and the following year he was appointed to the new position of National Clinical Director for Kidney Care for England at the Department of Health, which he held until 2013. As the inaugural ‘renal tsar’, he advised the government on the development of kidney care in a resource-limited NHS, and provided a much needed interface between government, the civil service and clinical leadership. His tenure was marked by a major expansion in the UK’s RRT services and the nephrology workforce. He advocated energetically for kidney disease, ensuring it was properly understood across the health community as a major non-communicable disease. He was an opportunist; with other enthusiasts he helped create a mandate for all UK clinical laboratories to routinely report estimated GFR (eGFR) alongside serum creatinine values. He rode the criticism that this would be misunderstood and drive unnecessary referral to nephrologists, especially among older people with chronic kidney disease, and he committed himself to the education programmes especially among primary care practitioners, that were needed to make this work. A transient surge of referrals soon settled and there was evidence of reduction in the high rates of emergency presentation of undiagnosed end-stage kidney disease. He then helped ensure that emerging evidence of suboptimal clinical care for people with acute kidney injury (AKI) was used to drive the introduction of mandatory real time digital reporting to clinicians of suspected AKI among in-patients, and championed the extensive education needed across the health community to drive improvements in AKI care.
Donal’s skills and gifts were ideally suited to the role of ‘renal tsar’. He had the intellect and clarity of thought to analyse the issues and provide rational solutions, as well as the charm, humanity and unstinting determination to make the case. He appreciated differing perspectives and could build consensus among clinical leaders, health managers and politicians. He was an early adopter of social media for communication of his plans and ideas. Donal was realistic enough to understand that he could not be popular with all the people all the time, and bore criticism with equanimity and patience. This was all aided by his natural gift of friendship and his freedom from self-importance. Throughout his career and in all of his professional circles he remained a very strong advocate for patients and carers, ensuring that their voice was always heard when kidney care was being planned and implemented.
His research interests developed in parallel with his interests in clinical care and service development. In recent years he published on the prevalence and management of CKD and AKI in the UK and worldwide, on the growing importance of supportive care for end-stage kidney disease, on taking opportunities to advocating for kidney disease, and on the importance of patient-orientated outcomes in clinical research. He became Honorary Professor of Renal Medicine at the University of Manchester.
He served the Renal Association as Treasurer (2003-2006) and then President (2016-2018). During his Presidency he led a re-structuring of the Association, with careful attention to governance, financial prudence, and diversity. He encouraged involvement of trainees and early years consultants in the Renal Association. The initial steps were taken to creating a single and truly multi-professional UK Renal society, which eventually became the UK Kidney Association.
Other leadership roles reflected his wide concerns for clinical service development, for the support of the workforce, and for patients and their carers. He was President of the British Renal Society (representing the multiprofessional renal team) from 2000-2003, and at the time of his death was chair of the patient support charity Kidney Care UK. For his services to kidney patients, he became OBE in 2018.
His skills and experience were increasingly valued in UK medicine beyond nephrology. He was a much respected and highly valued Registrar of the Royal College of Physicians of London from 2018 until his death. Prior to that he chaired the Greater Manchester, Lancashire and South Cumbria Senate and was medical director of Health Innovation Manchester. His reputation grew beyond the UK, and his advice on the development of nephrology services was sought by other healthcare jurisdictions. He recognised that the changes he led had been designed for the unique circumstances of the UK, but that their principles and the education and advocacy needed to drive through change were universal. In 2018 he became chair of the International Society of Nephrology Advocacy Working Group, a role ideally matched to his unique experience of interaction with governments and health system managers, his determination to ensure the patient voice remained at the center of health professional work, and his passion for advancing global kidney health in every setting.
Donal’s energy seemed boundless, and his love and commitment for his work and his family all-consuming. But there was a little energy left, which he reserved for his beloved Manchester United. He followed them with one-eyed enthusiasm, even inviting their manager Sir Alex Ferguson to open a new dialysis unit in Salford, and engaged by his charm he became its supporter. In 2014 the British Medical Journal published an interview with Donal that was revealing of his principles and priorities[1]. In it he says that being a doctor is ‘a ball’. He was continuing to ‘have a ball’ in nephrology right up until his sudden final illness. Many young doctors were inspired by his example, energy, mentorship and friendship to follow him into nephrology, and found that he was correct in loving every minute of it. The lives of those with kidney disease in many parts of the world are immeasurably better for his unrelenting work on their behalf.
Donal O’Donoghue died on 3rd January 2021 from COVID-19 infection. He is survived by his wife, Marie, their three children, Daniel, Kathryn and James, and by four grandchildren, all of whom he adored.
He is much missed by his close colleagues and many friends throughout the UK and worldwide. We miss what he gave us all, and are regretful in the knowledge that there would have been so much more.
[1] Donal O’Donoghue: Being a doctor is “a ball”. Brit Med J 2014;349:g5497 doi: 10.1136/bmj.g5497
