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Medical manpower affected pancreas donations

Five potential pancreas donations did not proceed to retrieval or transplant in 2018, against the backdrop of manpower deficits in transplant surgery, retrieval and anaesthesia.

Minutes of a meeting of the National Organ Donation and Transplant Advisory Group (NODTAG), obtained by the Medical Independent (MI) under Freedom of Information law, outlined how resourcing shortfalls are negatively impacting transplant services.

In December, the NODTAG discussed the issue of two declined pancreases “due to no anaesthetic cover”.

According to the minutes, Mr Emir Hoti, Consultant Transplant Surgeon at St Vincent’s University Hospital (SVUH), Dublin, noted the issue “was not only attributable to anaesthesia, but also limited resourcing in surgery. Same pancreas surgeon working back-to-back retrieval and transplant is not sustainable. Succession plan/back-up cover for current pancreas surgeon does not exist.”

The HSE’s Organ Donation and Transplant Ireland (ODTI) office “has requested funding for enhanced
retrieval services”, a spokesperson
told MI.

In early 2017, the national pancreas transplant service transitioned to SVUH. According to the HSE, the programme has since developed on a phased basis “to ensure adequate safety and quality of the service delivered”. Ten simultaneous pancreas and kidney transplants have been completed, five in 2017 and five in 2018.

The pancreas transplant programme is undertaken with support from renal transplant surgeons from Beaumont Hospital, Dublin. “Both teams perform retrieval and transplant surgeries. As the service continued to evolve in 2018, five potential pancreas donations did not proceed to retrieval or transplant with the evolution of the service.”

Last month, an SVUH spokesperson said no pancreas is retrieved from a donor without a number of criteria being met, for example, suitability for transplant, availability of suitable recipient, and availability of hospital resources. Only when these
criteria are met is the organ retrieved from the donor.

“Pancreas transplant surgery is complex and is currently undertaken Monday-to-Friday in our hospital. We are currently reviewing the resource requirements of the programme to ensure we continue to meet patient need.”

Meanwhile, the same NODTAG meeting in December also heard concerns from Mr Lars Nolke, head of lung/heart transplantation at the Mater Hospital, Dublin, about “vulnerability” of the service due to reliance on registrars “not exposed to retrieval on an ongoing basis”.

According to ODTI’s annual report for 2018, there were 81 deceased donors last year, down from 99 in 2017. There were 234 transplants from deceased donations, a decrease from 260 in 2017. There was also a drop in living kidney transplants performed during 2018 (40) compared with
2017 (51).

In his foreword to the report, ODTI Director Prof Jim Egan wrote: “An increase in organ donation infrastructure would save many lives. In an international context, such developments in Ireland are long overdue.”

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