Historical background

The transplant programme in the United Kingdom got underway in 1960 with a successful isograft kidney operation. (‘Isograft’ transplants occur between identical twins to virtually eliminate the risk of organ rejection.'Allografts' between non-identical twins run the risk of the of the donor organ graft being rejected by recipient patient.) The operation on the 49 year old donor twin was carried out by Mr James Ross and implanted in the patient by Sir Michael Woodruff at the Royal Infirmary of Edinburgh. It was not until 1965 in the UK that the first deceased kidney donation led to a successful transplant.

The first liver transplant took place at Addenbrooke’s Hospital, Cambridge in May 1968.

Consequently transplant expertise and the roles of the donor or transplant coordinators developed around the renal and liver clinics where transplants for these particular organs took place. That is why the coordinators were distributed unevenly around the country, following no particular plan or systematic pattern. By this I mean that the coordinators were generally located at the hospitals where organs were implanted into recipient patients, rather than at the hospitals where the donor organs became available.

The transplant programme extended to the first heart transplant in the UK on May 3rd 1968. This was the tenth heart transplant in the world and to be one of the last until the 1980’s. Donald Ross led a team of 18 staff to implant a heart in a 45 year old male recipient who survived for 46 days courtesy of the 26 year old donor named Patrick Ryan. Patrick was taken by ambulance from King’s College Hospital, London to the National Heart Hospital at Marylebone. (This hospital was closed in 1991 and absorbed by the Royal Brompton Hospital which is now part of the University College London Hospitals.)

If the transplant process had been designed from scratch and the whole range of tissue and organ transplants got going at the same time I’m certain that the NHS would have designed a more coherent approach to transplantation. Given its piecemeal development we have inherited a system today that has evolved in a manner which is neither rational nor effective. This is not a statement of criticism, but an acknowledgement of the pragmatic, often ad hoc development of transplant activity. In recent history there have been many government enquiries designed to increase the number of retrieved organs and life saving transplant procedures. There have been numerous recommendations designed to rationalise the transplant process. The most recent ones are listed below with the appropriate web links to the Department of Health website:

February 2000 “The review of the United Kingdom Transplant Support Service Authority (UKTSSA) 1998/99” [Department of Health web link]

March 2001 “Organ and Tissue transplantation: A plan for the future” [Department of Health web link]

April 2003 “Human bodies, human choices summary of responses to the consultation report” [Department of Health web link]

July 2003 “Saving lives, valuing donors: A transplant framework for England” [Department of Health web link]

October 2004 “Saving lives, Valuing donors: A transplant framework for England - One year on” [Department of Health web link]

July 2007 “On the state of public health: Annual Report of the Chief Medical Officer 2006” – Organ Transplants: The Waiting Game [Department of Health web link]

January 2008"Organs for transplants: a report from the Organ Donation Taskforce" [Department of Health web link]

January 2008 "Organs for Transplant – a supplement report" [Department of Health web link]

September 2008 “Increasing the supply of donor organs within the European Union” Command paper 7466 [Department of Health web link]

November 2008 “The potential impact of an opt out system for organ donation in the UK: an independent report from the Organ Donation Taskforce” [Department of Health web link]

February 2009 Organ Donation Taskforce Programme Delivery Board [Department of Health web link]

The Organ Donation Taskforce

The Organ Donation Taskforce was set up by the UK government in December 2006 to investigate why Britain has lagged behind most other countries in the 'developed' world in terms of the number of transplant procedures carried out.

The graph above is adapted from the data made available in the following review: “A systematic review of presumed consent systems for deceased organ donation” by A Rithalia, C McDaid, S Suekarran, G Norman, L Myers and A Sowden (Centre for Reviews and Dissemination (CRD), University of York ) - published May 2009.

The ODT and its recommendations are without doubt the biggest initiative undertaken by a UK government to save the lives of British people with end stage organ failure. The Taskforce has been given the authority to streamline a transplant community that developed in a very fragmented manner in the C20th to make it fit for purpose in the C21st. Thousands of lives depend on the succesful outcome of this enterprise.

January 2008"Organs for transplants: a report from the Organ Donation Taskforce" [Department of Health web link]

January 2008 "Organs for Transplant – a supplement report" [Department of Health web link]

September 2008 “Increasing the supply of donor organs within the European Union” Command paper 7466 [Department of Health web link]

To be continued.