UK's transplant system was world-leading - now it lags behind other Western nations

## Summary
UK's transplant system was world-leading - now it lags behind other Western nations 15 minutes ago Share Save Adam Eley and Michael Buchanan , File on 4 Investigates Share Save BBC Surgeons perform a double lung transplant at the Royal Papworth Hospital in Cambridge Jodie Cantle says she feels as though life is passing her by. Jess Jones, a patient advocate who has spent a decade looking into the transplant system, says the NHS must do far better at providing wraparound care that is able to deal with a patient's increased risk of complications. "There's no point doing incredible life-saving magical operations with incredibly skilled surgeons and then not investing longer term in what's really needed to keep these people well and to have good longer-term outcomes. "Australia, for example, has astonishing outcomes - 20% above what we do when it comes to five-year survival [rates]." Uneven service There are also striking variations between each hospital. Instead, in a statement, the DHSC said the government had inherited a broken NHS and it recognised "the systemic issues facing cardiothoracic transplantation and the impact this is having on patients waiting for a life-saving transplant, as well as their loved ones". A Birmingham surgeon speaking on behalf of NHS Blood and Transplant (NHSBT), which looks after services prior to transplantation, said NHSBT was aware of the problems in the system. "We're already trying to do better," Mr Aaron Ranasinghe told File on Four Investigates. "We're already doing better in terms of numbers of transplants building year on year.

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UK's transplant system was world-leading - now it lags behind other Western nations
15 minutes ago
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Adam Eley
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Michael Buchanan
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File on 4 Investigates
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BBC
Surgeons perform a double lung transplant at the Royal Papworth Hospital in Cambridge
Jodie Cantle says she feels as though life is passing her by. She is attached to an oxygen cylinder at all times, waiting for a double lung transplant.
Over the past seven years, the 34-year-old has been offered new lungs on 17 different occasions, but each time the operation has been cancelled.
"I feel the world is moving on without me," she says, "and I'm just here, on hold."
The UK used to be a world leader in the field - but has fallen behind major Western nations. The number of heart and lung transplants the NHS carries out each year has not increased in three decades.
BBC File on 4 Investigates has found that technology is outdated, there is a lack of investment and senior surgeons are leaving - while patients point to issues with ongoing care.
The government told the BBC it would be writing to the NHS demanding that it "urgently implement" recommendations, first set out in 2024, to make transplant services "fit for the future".
But those working within the system say they need more resources to improve care.
Long, frustrating wait
Jodie is one of 450 adult patients in the UK currently waiting for a heart or lung transplant.
Born with cystic fibrosis, a genetic disorder that causes mucus to become thick and sticky, she has just 9% lung function. A transplant is her only hope for a normal life.
She makes no criticism of her transplant centre, London's Harefield Hospital, but the long wait has left her frustrated.
Jodie Cantle has been offered new lungs 17 times, but each operation has been cancelled
One potential transplant did not proceed because the hospital didn't have a theatre available. On every other occasion, she was told the lungs were not good enough to use.
"You try not to let it take over your life, but it does," says Jodie. "You always have to have your phone on hand - if they get a match for lungs, I've got to drop everything and leave immediately."
Harefield says every decision involves "multiple, complex factors and our teams consider very carefully what is right for each person".
Unusable organs
While the number of organs donated in the UK is equal to, or better than, much of other parts of Europe per head, the NHS uses far fewer of the hearts and lungs it gets than most other countries. Just one in 10 lungs and one in seven hearts are transplanted. Some countries make use of twice as many.
Consequently, the NHS performs fewer heart transplants, and half as many lung transplants per head than many other European countries.
The NHS's poor performance is partly down to equipment, a dozen surgeons and experts have told the BBC.
They have spent years - often with little progress they say - asking for new technologies that are commonly used abroad.
For instance, the NHS has not invested in CT coronary angiogram machines, which allow clinicians to scan hearts to check if they are diseased.
Without detailed knowledge of the organ's condition, mistakes can occur. Surgeons have told the BBC that healthy organs can be discarded, and diseased organs can be transplanted.
Similarly, ice boxes continue to be used to transport hearts and lungs between hospitals in many instances. These can cause hardening of the transplant organs and lead to complications.
Modern alternatives to ice boxes are available that keep hearts beating and oxygenated while they are being transported. The cold-storage devices also assess a heart's viability, but they are only part-funded by the NHS.
In Glasgow, where those alternatives are used more often because of additional financial support from the Scottish government, the transplant centre says it has "substantially" improved its ability to accept donor hearts.
Poor survival rates
Even after a transplant has taken place, the UK system continues to struggle with follow-up care - its five-year survival rates lag behind the best in the world for both hearts and lungs.
Long-term support for organ recipients is vital, but patients who have spoken to File on 4 Investigates say it is not always available or is poorly administered.
Transplant patients need to continue taking medication to prevent a new organ from being rejected by the body. These can have toxic effects, raising the risk of skin cancer, kidney failure and many other health issues.
Zanib, 34, had a successful lung transplant in Manchester in January 2020, but five years later her kidneys began to fail and she was admitted to intensive care. She says the trust's renal specialists repeatedly ignored referrals from her transplant team to see her.
It was only when, while seriously ill, she brought her case to the attention of senior individuals at the hospital that Zanib received the attention she needed.
She now needs energy-sapping dialysis treatment thr

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## Expert Analysis

### Merits
- They have spent years - often with little progress they say - asking for new technologies that are commonly used abroad.
- NHS England, which was tasked with implementing report recommendations, says it has worked to "improve outcomes for patients", but surgeons and campaigners believe progress has been slow.
- According to Robbie Burns, a former executive director at NHS hospitals and transplant recipient, who now works as a patient representative: "There's been a lack of focus and a lack of oversight at a national level. "I think the improvement has been extremely marginal and nowhere near the level that we need to achieve our goal of being a world-leading transplant service." Sir Magdi Yacoub, an internationally acclaimed surgeon who helped establish the UK's once-leading reputation, told File on 4 Investigates that the NHS's issues stem from a continued lack of investment and deprioritising of services. "We need to have more people, more money, physical resources," he says. "We have all the expertise… but we have slipped back in applying it to [patients]." Responsibility for transplant services will soon be transferred to the Department of Health and Social Care (DHSC), following the decision to abolish NHS England.

### Areas for Consideration
- She makes no criticism of her transplant centre, London's Harefield Hospital, but the long wait has left her frustrated.
- These can have toxic effects, raising the risk of skin cancer, kidney failure and many other health issues.
- She now needs energy-sapping dialysis treatment three times a week to replace the job of her kidneys, which went into renal failure.

### Implications
- The government told the BBC it would be writing to the NHS demanding that it "urgently implement" recommendations, first set out in 2024, to make transplant services "fit for the future".
- These can cause hardening of the transplant organs and lead to complications.
- It has impacted her employment and social life. "The system… just doesn't work for patients like me," she says. "[We should] feel safe and supported, rather than more anxious, more vulnerable and more stressed." Manchester University NHS Foundation Trust did not comment on Zanib's case but said "patient outcomes and safety are at the forefront of our treatment plans for all our patients".
- The hospital "bends over backwards to make transplants happen to ensure that we say yes to every good donor organ", Papworth's clinical lead, Dr Steve Pettit, told File on Four Investigates.

### Expert Commentary
This article covers transplant, nhs, heart topics. Notable strengths include discussion of transplant. Areas of concern are also raised. Readability: Flesch-Kincaid grade 0.0. Word count: 1793.