Outstanding Achievement Award: Ms Dilly Little

Ms Dilly Little is the 2025 recipient of the RCSI Vice Chancellor’s Outstanding Achievement Award for her achievements in urology and renal transplant surgery, her commitment to clinical excellence and dedication to patient care. Read Dilly's story below.

My parents were both GPs – my dad was an RCSI graduate while my mum attended UCD. Unfortunately, my dad passed when I was young, but I grew up watching my mum practice as a rural dispensing GP. However, growing up I knew I always wanted to be a surgeon and as a student I found that I enjoyed anatomy and the clinical aspects of the course the most.

After graduating I started my internship in the Richmond Hospital and was part of the cohort who then moved to complete my internship in the newly opened Beaumont Hospital. During my internship I had the opportunity to work with Mr Dennis Murphy, who conducted all the urology consultations as well as Mr David Hickey, who was then his registrar. Listening to them, seeing them operate, really sparked an interest in transplant surgery and after Dennis allowed me to scrub in and assist with a few transplantations I was hooked.

After doing a postgraduate degree in Anatomy and Physical Anthropology in UCD in 1988, I was delighted to get on the basic surgical training programme. It was a fantastic experience, and I learned a lot from surgeons such as Mr Paddy Broe in Beaumont and Mr Dan Kelly in St Vincent’s. A further rotation in general surgery convinced me that urology was my passion.

Unexpectedly, I then ended up working as a registrar in vascular surgery with Professor Hayes – a slight diversion in my career but ultimately hugely beneficial due to the fact that there is a huge component of vascular surgery in transplantations. It taught me that when one door shuts another opens!

Wisconsin, Oxford and Oslo

In 1994, I had the opportunity to move to the University of Wisconsin as a Research Fellow in Transplantation, where I was mentored by Professor Hans Salinger, who was a groundbreaking transplant surgeon and researcher. The university had a significant transplant surgery programme ranging from liver, pancreas and kidney to cardiothoracic. It was a purely research role and I missed my clinical work, but it was invaluable in learning more about surgical research, particularly at a time when molecular biology was coming to the fore.

I had the opportunity to put a lot of cutting-edge molecular biology into practice by conducting research involving gene therapy modalities which gave me a much greater understanding into the role of immunology in transplantation. Seeing how the university set up their services was also hugely beneficial and informed a lot of my thinking on how a day-to-day transplant programme could be structured.

I completed my MD over the course of two years in Wisconsin before returning to Beaumont as a Urology SpR. When the opportunity arose to apply for a consultant position in Oxford, I was appointed there in 1998. I spent just over two years working in Oxford alongside Professor Sir Peter Morris, who pioneered a lot of immunosuppression research. It was quite an intense working experience as the team was short-staffed, but I learned a lot particularly as the team were doing a lot of operations with living kidney donors.

I returned to a consultant post in Beaumont in 2000 but then in 2010, I moved to Oslo for two months to train in laparoscopic donor nephrectomy. Along with my colleague Molly Eng, I trained under Professor Per Pfeffer at the University of Oslo doing hand-assisted laparoscopic donor nephrectomy. When we arrived back in Ireland we conducted the first operation of its kind in Ireland in November 2010. To date I’ve been involved in over 600 such operations.

A changing landscape

It has been fascinating to see the changing landscape of transplant surgery in Ireland not just in terms of technique but also in relation to policy and legislation.

One of the biggest changes was the shift in emphasis from deceased donor transplants to the living donor transplant programme. In the 1970s, Ireland had a living donor programme in place but by the early 1980s it was felt that the deceased donor programme was sufficient to meet the transplantation requirements. Year on year, there was a steady growth in multi-organ retrieval from deceased donors and as a result there was no real emphasis on the living donor programme.

This began to change in the 1990s when waiting lists began to grow and in terms of surgical technique, the increased demands on the living donor programme also led to a change from an open surgical approach to minimally invasive nephrectomies.

Another evolution that took place relates to the structure of the transplant team, which is now truly multidisciplinary. From the 1970s, when the kidney transplant programme was delivered primarily by urology services, to the present day where there is an integrated multidisciplinary service involving collaboration across nephrology, immunology and transplant surgery.

The advancement of immunology and immunosuppression has been immense, leading to much better outcomes within both the deceased and living donor programmes. Interestingly, however, we are also seeing how the success of other solid organ transplants leading to longer survival times can then result in kidney failure due to some of the side effects of immunosuppression. We are also seeing a higher rate of retransplants, which are often very challenging.

An ongoing challenge is the recruitment and retention of transplant surgeons. It is a hugely demanding and often unpredictable schedule. While living donor transplants can be scheduled, they are often very complex and involve a significant amount of preparatory work by nephrology, virology, psychology, anaesthesia, immunology and radiology. Then, regarding the deceased donor transplants you simply do not know when a call might come through with a deceased donor offer.

Future development will include the development of uncontrolled donation after circulatory death, which has been implemented in other European countries including Spain. I also feel strongly about the need to build on recent commentary and legislative developments to increase altruistic donation.

Realistically when you compare our population to other countries, we should be conducting about 60 to 70 operations as part of the living donor programme annually. I believe it is important to address the misconception that you need to be genetically related to donate a kidney and to explore avenues such as mentorship, through which a patient might feel more comfortable with a mentor asking a family member or friend on their behalf.

The altruism of donors

I am genuinely so proud to have worked within the transplant service and the urology service , to which so many colleagues have given an amazing amount of time and effort. Above all though, I feel very humbled and inspired by the patients, donors and donor families.

The patients are by and large the most extraordinary group of people you can work with. Many are very unwell with a chronic debilitating kidney disease and so much has gone wrong for them, but they are incredibly hopeful and positive.

Our service simply would not exist without the altruism of donors and donor families. I am so struck by the unbelievable strength of the families who often following a tragedy consider donation of their loved one’s organs.

Likewise, the fact that living donors are literally giving of themselves. It is an absolute privilege to work with these people.