More doctors and donors needed for transplantation in the UK

BMJ 1999; 318 doi: (Published 06 February 1999) Cite this as: BMJ 1999;318:350
  1. Zosia Kmietowicz
  1. London

    More doctors and twice the number of donors are needed to avert a worsening crisis in transplant surgery, warned the Royal College of Surgeons last week.

    Waiting lists for organ transplants are continuing to grow but the number of cadaver donors has remained at around 900 a year since 1990, according to the report by a two year working party into the state of transplant surgery in the United Kingdom. At any time, 4500 people are on a waiting list for a heart, liver, or lung transplant, and 1 in 5 dies while waiting.

    Professor Sir Peter Morris, Nuffield professor of surgery at the University of Oxford and chairman of the working party, said: “It is not an exaggeration to say that the provision of organ transplantation as a service is on a knife edge, the two major problems being an inadequate supply of organs to meet the demand and an acute shortage of transplant surgeons.”

    Transplantation has, in effect, become a victim of its own success. It is now the preferred treatment for most cases of major organ failure, with 75%of patients being fully recovered five years after surgery. However, the fall in the number of people suffering cerebral haemorrhage after road traffic accidents means that there are fewer suitable young donors. For example, fewer than 1 in 3 patients waiting for a kidney transplant receives one.

    The college would like to see the number of donors registered with the UK Transplant Support Service Authority double from the current total of just under 5 million to 10 million in the next two years. It hopes to meet this objective through an education programme targeted at schools.

    More doctors need to train as transplant surgeons. The college estimates that an additional 21 kidney transplant surgeons, 15 liver surgeons, and seven heart surgeons are needed. Doctors often choose other specialties because of the poor working conditions associated with transplantation, said the report.

    “There is a lot of out of hours work with doctors often being on call every other night rather than the preferred one in four nights. Surgeons have to work in small teams, and a lot of the work of transplantation has become routine,” explained Sir Peter. “We need to rationalise the service so that staffing can be brought up to sensible levels.” One way to attract more trainees, he suggested, would be to incorporate transplant surgery into general surgery so that doctors get a variety of work.

    The college would also like to see the creation of a national transplant service to replace the transplant authority and what it calls “the current piecemeal strategy for transplants.” The new service would be responsible for retrieving and allocating organs nationally, and evaluating and maintaining standards.

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