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Organ donor shortage versus transplant rates

By David Talbot

The article in this week’s Times with the commentary written by Chris Watson illustrates the significant changes that have happened in transplantation over the last two years. In 2008, the Organ Donor Taskforce (ODTF) came up with 14 recommendations to address the problem of donor shortage, and then UK Transplant (which then changed to Blood Transplant) acted upon these.

In addition to these changes, organ donation surgery became restricted to six zones whereas before the ODTF recommendations, all 26 transplant units in the country contributed to cadaveric organ donation. Also, the national sharing of organs (which had been voluntary, in so far as we aimed to serve our own community primarily and additional organs were shared only in certain cases) became enforced. This essentially was because there was a postcode imbalance, and some kidney failure patients waited six years for their transplant whereas in the northeast, patients generally waited only for 18 months.

The reasons for this imbalance were complex and were partly influenced by certain ethnic minority populations who didn’t support cadaveric donation while simultaneously making up a significant percentage of the number of patients who needed a transplant.

Additionally, different transplant unit structures had varying degrees of enthusiasm for donation. The work force obviously recognized these problems and tried to unify the approach and also ensure equality of access.

On a personal level, I was reluctant to throw my lot in with these national developments because our transplant population had a good deal! Indeed, with the national sharing mechanism, our local transplant rates initially fell, resulting in an increased waiting time.

The ODTF 14 point plan was, to me, an experiment which should be abandoned if it didn’t work. However, its effect was to promote donation by embedding Transplant Coordinators in most hospitals, thereby insuring that potential organ donors are not overlooked. In addition, numbers of Non-Heart-beating donors (aka donor after cardiac death), thanks to our pioneering work, have really taken off, accounting for 37% of cadaveric kidney transplants nationally. So although from a local level the national sharing scheme was a bad idea at the time, because of the promotion of donors through the enactment of the ODTF plan, the transplant numbers have now increased nationally, so my concerns for the future have proved wrong.

For example, I was on call for the week between Christmas and New Year and we did six kidneys and two liver transplants. Last week, I was again on call, and we did a liver, a kidney/pancreas, three live donor kidneys, two double kidney transplants, and an islet transplant! On the background of this our unit did 135 cadaveric donors last year.

Our next pressing problem is surgical exhaustion!

David Talbot is a Consultant Transplant Surgeon at Newcastle Hospitals NHS Trust and co-author of Organ Donation and Transplantation After Cardiac Death.

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