Current Research in Organ Donation and Transplantation
Research into organ donation and transplantation in the past has concentrated on events post-transplant, now more effort is being made to understand how to improve the quality of organs prior to donation. NHSBT research will focus on:
- A co-ordinated programme of research to improve number and quality of organs for transplantation
- Planning for a transplant biobank of donor and recipient samples to support future research projects
- Outcome studies derived from information in the transplant database
Measures of donor organ quality are used characterise the chance of graft failure in transplant recipients. They may be used to monitor changes in organ quality over time, to assess the attitude of different transplant units to wards poorer quality organs, in organ allocation, and in the provision of risk adjusted outcome data. Such indices have been in use for some time, but they are generally based on data from the US, and so may not be appropriate for UK donors. Some while ago, a UK Kidney Donor Risk index was developed (Watson et al, 2012). A US liver donor risk index was proposed over ten years ago, but this has the disadvantage of including cold ischaemic time, and so cannot be used at the point of retrieval. Accordingly, a UK liver donor quality index is now being developed.
Watson CJE, Johnson RJ, Birch R, Collett D, Bradley JA. A simplified donor risk index for predicting outcome after deceased donor kidney transplantation. Transplantation, 2012; 93: 314-318
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Patients who receive an organ transplant face many adverse events, including rejection, organ failure, haemorrhage, sepsis, and malignancy. In work carried out several years ago, Collett et al (2012) showed that the 10-year incidence of de novo cancer in transplant recipients is twice that of the general population. Some cancers, namely nonmelanoma skin cancer, cancer of the lip, post transplant lymphoproliferative disease and anal cancer have the greatest incidence, and the incidence of different types of malignancy varies between organ types. In subsequent work, the risk of transmission of cancer from donor to recipient was shown to have a very low risk. These results help clinicians in counselling patients about the risk of malignancy following transplant.
Desai, R, Collett D, Watson, CJ, Johnson, P, Evans, T, Neuberger, J. Cancer Transmission from Organ Donors-Unavoidable But Low Risk. Transplantation. 2012; 94(12): 1200-1207, Collett D, Mumford L, Banner NR, Neuberger J, Watson CJ. Comparison of the incidence of malignancy in recipients of different types of organ: a UK registry audit. American Journal of Transplantation 2010;10: 1889–1896
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The National Institute for Health Research Blood and Transplant Research Unit (BTRU) in Organ Donation and Transplantation
This new Unit opened on October 1st 2015 and receives a total of £3.8M of funding from the NIHR over five years to support key staff, trainees and consumables. The BTRU is a strategic partnership between the University of Cambridge and Newcastle University, and their associated transplant units, and NHS Blood and Transplant (NHSBT). The overarching aim of the BTRU is to develop and evaluate novel approaches and technologies that will increase the availability of suitable donor organs for transplantation, while improving graft survival. To help achieve this we are strengthening existing links and building new collaborations between leading scientists and clinicians to create a BTRU that attracts the best young doctors and scientists and helps them develop into the future researchers in transplantation.
The focus of our BTRU is on the clinical pathway from identification of a potential deceased organ donor to the implantation of the donor organ into the most appropriate recipient.
Our BTRU has four key objectives:
- To improve organ donor management and evaluate novel interventions in deceased donors.
- To develop novel approaches for assessing donor thoracic and abdominal organ quality.
- To evaluate normothermic ex vivo perfusion as an approach for resuscitating and reconditioning thoracic organs and kidneys that have been removed from the donor.
- To reduce the demand for re-transplantation through improved understanding of donor/recipient compatibility and the use of novel interventions to protect and improve long-term graft function.
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