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Overview

Royal Papworth Hospital's heart and lung transplant programme is the biggest and most experienced unit in the country, treating patients from across the United Kingdom. Teams here perform approximately 90 adult heart, lung and heart-lung transplants each year, including about 50% of the UK's cardiothoracic DCD activity. 

In addition, the transplant team also implant Ventricular Assist Devices which acts as a bridge for some patients on the heart transplant waiting list. 

Cardiothoracic transplantation

Royal Papworth Hospital is the country's main adult heart and lung transplant centre and has carried out a number of UK, European and world first transplants since the UK's first successful heart transplant operation at its old hospital in Papworth Everard in 1979. It is also a world-leader in DCD heart transplantation. 

Since then, we have carried out almost 3,000 heart, lung and heart-lung transplants, with world-leading survival rates, the shortest waiting lists and an increasing number of patients living 30+ years post-transplant. 

Teams at Royal Papworth have conducted the most heart transplants every year in the UK since 2008/09 and is the most active adult cardiothoracic transplant programme. In 2019/20, we performed 80 transplants which was more than any other UK centre, with survival rates consistently above the national average. 

The hospital has also pioneered the use of invasive monitoring and hormone resuscitation for managing multi-organ donors which has become the international gold standard in donor management.

Innovation: UK, European and world firsts

In 1979, Royal Papworth Hospital performed the UK's first successful heart transplant. This was followed five years later by the first successful heart-lung tranplant in the UK and the world's first heart-lung and liver transplant in 1986. 

In 2015 a team at Royal Papworth Hospital became the first in Europe to successfully perform a transplant using a non-beating heart from a circulatory determined dead (DCD) donor. Up until then our transplant team were only able to transplant hearts from donors following the diagnosis of brain-stem death (DBD). 

The transplant team at Royal Papworth Hospital took this one step further when, in June 2019, the world's first DCD heart-lung operation was performed on a 24-year-old patient. 

View a full timeline of the history of transplantation at Royal Papworth Hospital

DCD heart transplants

Royal Papworth Hospital is a world-leader in DCD heart transplantation, having performed the first in Europe in 2015 and more than any other centre worldwide.

Donation after circulatory death (DCD) refers to the retrieval of organs for the purpose of transplantation from patients whose death is diagnosed and confirmed using cardio-respiratory criteria. Essentially, their heart has stopped beating and is no longer circulating blood around the body following the planned withdrawal of life-sustaining treatments. 

Previously, all transplants were after brain-stem death (DBD); a person's heart is still beating but they no longer have any brain functions and will not be able to breathe without mechanical support.

In October 2018, Royal Papworth Hospital's DCD heart transplant operation was used on the 50th patient. It continues to be the biggest such programme in the world with 90 transplants now performed and in 2019/20 accounted for 50% of the hospital's heart transplant activity.

Now in its fifth year, short and mid-term survival via the DCD method at Royal Papworth Hospital is comparable to DBD heart transplants with similar length of stay in intensive care and total stay in hospital post-transplant.

Read more in The Journal of Heart and Lung Transplantation - '5-Year Single Centre Early Experience of Heart Transplantation From Donation After Circulatory Determined Death (DCD) Donors'.

 


Fran Middleton received a DCD heart transplant at Royal Papworth Hospital in 2018

UK heart and lung transplant audit report 2019/20

NHS Blood and Transplant's 2019/2020 cardiothoracic audit report was published in September 2020. The report lists a number of highlights for Royal Papworth Hospital:

  • We performed the highest number of heart transplants and the highest number of lung transplants of any UK centre in 2019/2020, making us the UK's biggest cardiothoracic transplant unit.
  • We had the shortest waiting time of any UK centre for a routine heart transplant or a lung transplant, which means our patients are more likely to get transplanted.
  • We had the lowest decline rate of any UK centre for both donor hearts and donor lungs, meaning our team is the most likely to say yes to donor organs.
  • Our patients have the best survival at one year and five years after listing for heart transplantation. This means our care is excellent throughout the patient journey, from selection, through time spent on the waiting list, to actually undergoing a transplant and then throughout post-transplant care.

However, the number of patients on both the heart transplant waiting list (340) and the lung transplant waiting list (346) is at an all-time high nationally, which means that demand is rising. At three years after being listed for a routine heart transplant in the UK, only 17% of patients have been called in from home for a transplant. This is 47% for lung transplant patients, which shows there continues to be an unmet need. 

If you would like to be an organ donor, please join the organ donation register and communicate your decision with your family. You could save up to nine lives. 

View NHS Blood and Transplant's annual report on cardiothoracic organ transplantation

Mechanical devices

Royal Papworth Hospital has a long history of innovation in heart and lung transplantation and has been using mechanical circulatory support devices to treat patients with end-stage heart failure since the 1980s.

Sometimes, very sick heart failure patients require bridging therapy before transplantation. This can be through the insertion of a mechanical blood pump to assist the left ventricle of the heart, known as a ventricular assist device (VAD). Patients fitted with these devices can be independent within the community while waiting for a suitable donor heart.

Patient referrals

Patients are referred to the service by their local GP. The transplant physicians decide if the patient would be suitable for an outpatient and/or inpatient assessment. It is usual for a family member to accompany the patient on these visits. A range of planned tests are carried out and the process culminates in a multidisciplinary team meeting which discusses the options for each individual patient and makes recommendations for their future care. These options are then discussed with the patient.

Useful resources

Adult Lung Transplants in the UK - NHS Blood and Transplant infographic 

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Adult Heart Transplants in the UK - NHS Blood and Transplant infographic 
 
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