New technology gives fresh hope to liver transplant patients

Organ transplants have saved thousands of lives over the years but the length of time that an organ can be kept alive outside the body has placed constraints on the number of transplants that can be performed. Livers, for example, are currently cooled to 4°C to preserve them. However, they continue to deteriorate and must be used within about 12 hours, severely limiting the window of opportunity for surgeons to operate. In fact, currently only about 650 liver transplants are carried out annually in the UK and demand far outstrips supply. This could be about to change.

In a world first, a team of scientists at Oxford University has developed a machine that can warm the liver to body temperature while maintaining a circulation of blood, oxygen and nutrients. This allows it to function as it would inside the body, meaning that it is not only preserved but can also repair itself, give doctors the opportunity to examine it for defects and, crucially, allow doctors more time before they have to operate.

Researchers believe that the machine will keep livers alive for at least 24 hours and tests indicate that 72 hours or more is not beyond the realms of possibility. Also, the machine is portable (about the size of a supermarket trolley) and could be modified to help preserve other organs and to test the toxicity of new medicines.

To date, in a pilot trial at King’s College Hospital in London, two patients have been given livers kept alive by the new machine. In neither case have there been any complications. The first, 62-year-old Torbay man Ian Christie, was diagnosed with cirrhosis of the liver last May and told that, without a transplant, he could die within 18 months. He is delighted with the results.

Oxford’s Professor Constantin Coussios, who helped develop the device, is amazed at the success of the trials, while Professor Nigel Heaton, Director of Surgery at King’s, has described the new development as a potential “bona fide game changer.” He says that the extra time it affords gives patients extra options. Echoing these sentiments, Wayel Jassem, the surgeon who performed the transplants, says that the new technology represents a major breakthrough that could herald exciting changes in liver transplant practice.

NHS could charge a call out fee for doctors

According to a report issued by the NHS Confederation, the body that represents all NHS trusts, frank discussions are needed on ways to shore up NHS finances. Among the suggestions outlined in the report as means of raising funds are proposals that patients should be charged for calling out a doctor to their home (a pilot scheme has been trialled in Germany) and should pay for meals. Patients should also have to pay to watch television, an idea that some NHS trusts are already considering.

Although the Confederation said that there are no plans in place to initiate a system of charges, opponents have expressed outrage. The proposed call out charge, set at £8.50, has raised concerns about patent safety. In fact, one survey has found that if a charge was imposed 24% of patients would delay in making a call to the doctor, while some 18% would not call at all. Katherine Murphy, Chief Executive of the Patients Association, claims that such charges would amount to a tax on patients and are contrary to the NHS’s principle of “free at the point of use.” She adds that patients should not have to pay for reform of the NHS through new charges.

Chief Executive Mike Farrar, however, says that open and honest discussions are needed about why the NHS must change. He says, “We cannot risk the wheels coming off and patient care suffering.”

The report warns that the NHS may need radical proposals as it faces spiralling costs caused by an ageing population and rising levels of obesity. The NHS currently spends 1.5% of its annual £100bn budget on propping up Private Finance Initiative but this figure is expected to double in the next ten years. In 2012, for the first time an NHS trust went into administration and officials estimate that another 20 are facing a severe crisis.

Cardiac patients can access their surgeon’s performance record

At its annual meeting held in Brighton in March, the Societyfor Cardiothoracic Surgery (SCS) announced that patients about to undergo heart surgery will have access to a range of information, including details of their surgeon’s past performance and other health statistics. This information will be available via a website, Blue Book Online, which is designed to raise the transparency of the medical profession.

Due to scandals at the Bristol Royal Infirmary where 35 babies died and others suffered permanent damage due to failures in cardiac surgery and high death rates at Mid-Staffordshire Hospital, cardiac surgeons have had to become more open about their performances. SCS President James Roxburgh believes that wider availability of data and transparency might be the only way to prevent further instances of serious failures of clinical governance.

According to Professor Ben Bridgewater, a cardiac surgeon at University Hospital of South Manchester, the number of patients using the Internet to access clinical information about their care has increased exponentially. He believes that the Internet is the ideal way for up-to-date data to be made available and that greater transparency will encourage the medical profession to act more in the best interests of patients.

Until now, data relating to mortality rates following cardiac surgery and the performance of some 80% of surgeons has been published on the website of the Care Quality Commission.