The risk of patients missing out on essential transplants due to the increasing breakdown of outdated equipment at the National Histocompatibility and Immunogenetics Service for Solid Organ Transplantation (NHISSOT) was highlighted as a “major concern” by its medical director recently.
In January 2019, Dr Mary Keogan, Consultant Immunologist and Medical Director of the NHISSOT, based at Beaumont Hospital, wrote to hospital CEO Mr Ian Carter stating that the service was “experiencing significant downtime” of both of its flow cytometers “and worryingly we have had times when both machines are non-functional and we are unable to provide a crossmatching service”.
“Luckily when this has occurred to-date there has not been a donor and so no patient has been harmed. However, the risk of patients missing out on essential transplants, and particularly for cardiothoracic organs being exported, is a major concern.”
Dr Keogan’s correspondence, cc-ed to the HSE Deputy National Director of Acute Operations Ms Angela Fitzgerald, stated that “we have been flagging the perilous state of this equipment for several years at every management review and have undertaken every step of which we have been advised”.
One flow cytometer is over 25 years old and the other has been in Beaumont for over 15 years and was not new when acquired. Such equipment generally has a life span of seven-to-10 years, according to the correspondence obtained from the HSE under Freedom of Information legislation.
A replacement machine costs around €100,000 and an extra €12,000-€32,000 with a plate reader, according to a business case by the NHISSOT in 2018 for Beaumont’s Non-Pay Committee.
“When the two flow cytometers are out of service due to unscheduled repairs, no crossmatching is available. This downtime risks a serious impact on the kidney, pancreas, heart, lung and living donor programmes, as a longwaiting, highly sensitised patient may miss out on their only chance of transplantation and there is a possibility of organs being exported. When the opportunity of a heart/lung transplant is lost, particularly for a highly sensitised patient, there is a risk of death on the waiting list.”
At press time, a Beaumont Hospital spokesperson said “cytometers equipment already ordered with anticipated delivery date in March 2019”.