Making transplantation green

About the working group

The NHS Blood and Transplant (NHSBT) Working Group on Environmental Sustainability in Transplantation was created by Prof. Derek Manas (Medical Director for Organ and Tissue Donation and Transplantation) with Dr Matt Welberry Smith (Consultant Transplant Physician, Leeds) and Mr John Callahan (Consultant Transplant Surgeon, Oxford and Coventry) as co-chairs.

The group initially aimed to provide the organ transplantation community with a straightforward tool for Transplant Units to use to move to more environmentally sustainable practise, resulting in this document.

The group is now in the process of more detailed examination of various parts of the transplant pathway, the results of which will be made available widely once completed.

Download a copy of the sustainability tips below (PDF 184KB)

Tips for a sustainable unit

Communicate and Engage

Set up a Green/Sustainability Working Group in your unit with leadership representation.

Consider designating 'Green Champions' to drive projects forward
- Use the resources available on the Centre for Sustainable Healthcare website to support your Green Champions with engaging colleagues
Ensure broad involvement across the service (e.g. anaesthetics, theatre management, outpatients, immunology services, dietetics, psychology, and more)
Consider carbon literacy training
Use Quality Improvement activity
Join the relevant sustainability networks through the Sustainable Healthcare Networks Hub to share good ideas, opportunities and encouragement
Engage with Operational Delivery Networks and other regional structures like Transplant Collaboratives on sustainability, sharing ideas, activity and best practise
Get your patients involved as patient ambassadors on sustainability, read the community ambassador template

Reduce and decarbonise travel

Consider how to reduce travel for your unit.

Patient travel

Aim to offer at least 25% of clinics virtually
Create or use one stop diagnositc/treatment hubs to reduce the number of visits to your unit
Try to reduce aborted transport (e.g. hospital transport sent to patients who are away or already in hospital
Set up a regular review of hospital transport processes for your unit

Staff travel

Use clinics localised to the patients where possible to reduce overall travel
Promote flexible working (including working from home) where appropriate
Actively avoid non essential flights, including for organ transplantation
Use low carbon routes when travelling to meetings and conferences

Use of flights

Make every effort to reduce use of flights whether for organ transportation, staff movement, conferences or supply chains

Adopt 'green' theatres

Adopt the intercollegiate Green Theatre checklist. Find out more about the checklist or download the Green Theatre Checklist (PDF 364KB)
Anaesthetic considerations. E.g. Total Intravenous Anaesthesia (TIVA) and re-usable equipment
Preparation for surgery. E.g. Adoption of reusable textiles and reduction of water consumption
Consider what intra-operative equipment is essential or optional. Reduce, reuse, replace
Post-operative care. E.g. Greener waste streams, recycling batteries and metals and turning off any equipment no longer in use

Increase transplantation

Find ways to increase the number of transplants in your patient population, this includes both living (where appropriate) and deceased donors
Create specific and measurable targets to improve access to transplantation for disadvantaged groups appropriate to the population the unit serves
Improve organ utilisation - review the Organ Utilisation Group recommendations and apply them to your unit
For kidney units, remember that kidney transplants are greener than dialysis and pre-emptive transplants help even more
Set measurable strategic targets to increase living donor transplantation

Improve graft survival

Apply interventions that have been shown to reduce injury at transplantation and/or reduce post transplant damage
Apply evidence based interventions to improve graft survival, and life years gained, in longer term transplant management
Make use of both prehabilitation and rehabilitation around transplantation
Focus on reducing poor concordance where appropriate

Get an environmental audit of your transplant unit

You can request an environmental audit through estates and facilities. This audit may have already taken place in many Trusts and can lead to many outcomes which help the Trust as well as the environment, such as:

Retrofitting buildings to reduce heat loss with cost effective insulation
Improving resilience of the estate to cope with high temperature environmental events
Utilising smart heating to maintain appropriate temperatures at specific times (E.g. adjusting temperatures when buildings are occupied or empty)
Switching all lights to LEDs

You can also work with IT to ensure energy efficient monitors and computers are being used.

For leaders

Lead in these areas or encourage and support your Trust leadership in the following:

Aim for 100% renewable energy by decarbonising energy sources
Improve the impact of procurement as this is a significant component of a unit's carbon footprint. Any significant or recurring purchases need careful consideration from an environmental perspective
Consider where funds are banked and switch accounts away from banks that promote funding for fossil fuels or single use plastics. This matters at an individual level too - find out which banks promote sustainable practice
Promote engagement with innovations that improve sustainability
Help the transplant unit green/sustainability group engage with the Trust level sustainability group and strategy
Promote the known positive overlap between Quality Improvement activity and sustainability