- Most centres now considering just the “most urgent patients”, and cessation of all transplants “may only be days away”
- Donations have also been cut by almost 50 per cent under new national rules
- Any delay in transplantation can result in death, with 400 people dying in 2018-19 while on the active waiting list
Major transplant centres have stopped performing many of their procedures due to the coronavirus pandemic, while the national coordinating body says a complete cessation “may only be days away”.
Reasons for the suspensions include a lack of critical care capacity, staff shortages and difficulties in segregating covid-19 patients.
Transplantation is a last-resort treatment for people suffering from organ failure and patients can die if they are left waiting too long for an organ.
NHS Blood and Transplant, the special health authority that coordinates donations, told HSJ that most transplant centres are now only considering the “most urgent patients”.
The authority has already written to hospitals asking they cut the number of potential donors by almost 50 per cent. HSJ understands this is to reduce the use of intensive care beds as organ donors must remain on ventilators until the organs are ready to be removed.
England has 23 transplant centres, with an additional five in the Scotland, Wales and Northern Ireland.
On Thursday, 2 April, a spokeswoman for NHSBT said: “Lung transplant centres are only taking urgent and super urgent patients at this time, two units have suspended their transplant programmes as they don’t have any patients in these categories on the waiting list.
“Liver and heart transplant centres are prioritising their most urgent patients. This [is] to support the NHS in treating COVID-19 patients and other patients needing intensive care…
She said there were still seven kidney transplant centres that had been able to stay open and were only considering their more urgent patients on the waiting list.
But she added: “A complete cessation of activity is not, now, universally supported by the clinical community… but we also acknowledge that this time may only be days away…
“Transplant teams will also talk to patients awaiting a transplant operation and balance their need for a transplant against the additional challenges of being immuno-suppressed at this time and the challenges being faced within the NHS at this moment.”
In 2018-19, the latest year for which data is available, 400 people died whilst on the active transplant waiting list. A further 780 were removed from the list that year, which in most cases would have been as a result of deteriorating health and they would have died shortly afterwards.
The decision to stop an organ donation and transplantation programme sits with the individual commissioners and trusts.
A spokeswoman for Kidney Care UK said: “Deceased donations have more or less completely stopped to protect the resources of the health service and to protect people themselves. It’ll be hard for people on the waiting list. We have heard from people who are obviously very upset and saddened but they understand why the decision has been taken”.
Oxford University Hospitals Trust, a major transplant centre, told HSJ: “We have taken the difficult decision to temporarily suspend transplant programmes, with the exception of the kidney programme for patients that do not require ICU beds.”
The trust also confirmed the move was in part to protect the “safety” of their patients waiting for transplants. Public Health England has said organ recipients are in the “shielding” group of people who are at high-risk from covid-19.
NHSBT said it may also temporarily change the way it allocates organs to those in need. Currently organs are allocated on a regional basis and calculated to ensure each transplant centre has a similar number of organs offered to them.
NHSBT is now investigating whether “local retrieval and more local allocation” might be adopted, which might mean that people in the area near to the organ donor would be offered the organs to “keep transplantation managed, effective and safe”.
HSJ asked all major transplant centres in England whether they are continuing with their transplant programme. The Royal Free London Foundation Trust, Liverpool University Hospitals FT and Newcastle upon Tyne Hospitals FT referred HSJ to NHS England or NHSBT. The others did not respond.
NHS England was approached for comment.
HSJ interviews, NHS Blood and Transplant statements