Five years on from staff at Royal Papworth Hospital performing the first adult DCD heart transplant in Europe, the NHS has today launched a new UK-wide retrieval and transplant service.
Before 2015, all donor hearts came from people who were brain-stem dead (DBD), but their heart is still beating.
With donation after circulatory death (DCD) transplants, the heart has stopped beating in the donor and is transferred to a machine – called Organ Care System – where the organ is reanimated and assessed. If the heart is suitable, oxygenated blood is continuously perfused into the coronary arteries to keep the heart beating outside the human body whilst it is transported to the recipient’s hospital for transplantation.
This revolutionary method has increased the number of heart transplants performed at Royal Papworth Hospital by 40%.
Worldwide there have now been approximately 200 DCD heart transplants; 85 of them have been performed by teams at Royal Papworth making it the largest such programme in the world. At the same time, they have also proctored a number of other UK centres in establishing their own programmes and advised hospitals internationally.
The majority of those 85 DCD adult heart transplants have been funded by Royal Papworth Hospital Charity, but with increasing data to show that mid- to long-term survival rates match – and in some cases better – DBD transplants, a Joint Innovation Fund provided by NHS Blood and Transplant and NHS England began financing the OCS machine equipment this year.
A DCD heart is kept beating on a machine called Organ Care System while it is transported from the donor to the recipient
Each centre continued to retrieve their own DCD heart, taking it back to their hospital for further assessment and potential implantation into a recipient.
Under the new system, however, which goes live today, Royal Papworth in Cambridge, Wythenshawe in Manchester, and Harefield in London will join together to provide a national retrieval service for each other and the other three adult cardiothoracic transplant centres – Newcastle, Glasgow and Birmingham.
“This arrangement will mean that each of the three hospitals are ‘on call’ for the UK for a week at a time. We will be on call for two weeks out of four, with Harefield and Wythenshawe each doing a week,” explained Jen Baxter, Lead Nurse for Retrieval and Organ Care Practitioner at Royal Papworth Hospital NHS Foundation Trust.
“It will work like this; if we are on duty, our DCD retrieval team will go to where the donor is, and if the organ meets the criteria we put the heart on the perfusion machine, accompany it to whichever hospital the recipient is based at and then when the heart comes off the machine and starts to be implanted, we will return to Royal Papworth Hospital ready to do it all over again.
“It’s then the same process for Wythenshawe and Harefield’s teams when they are on duty.
“We are very excited for this new service going live and look forward to working closely with other units and colleagues to improve care for patients.”
Despite DCD transplantation increasing the number of hearts available for transplant since 2015, supply still falls short of demand with patients dying on the waiting list. It is hoped this new service will help to reduce the shortfall.
The Joint Innovation Fund is for a maximum of three years and, in the first instance, will run as a 12-month pilot.