Pathology services

The effective transplantation of organs from a donor to several recipients requires initial investigation to determine the compatibility of donor and recipient. Investigation can also help determine the expected level of function from the transplants. The safe transplantation of organs requires assessment of the level of risk of donor-transmitted disease, including infections and tumours.

Some of the basic tests on donor characterisation, to assess the level of function in the donor organs and estimate the risk of infection, are conducted in the hospital where the donor is being treated. Many tests form part of the treatment they received before being considered as a potential donor. Other tests are done by, or on behalf of, NHS Blood and Transplant (NHSBT).

Determining the compatibility of donor and recipient is based on tests done in the histocompatibility & immunogenetics laboratories. In England and Wales, NHSBT mainly run these laboratories with separate commissioning arrangements in Scotland and Northern Ireland.

The possibility of donor-transmitted cancer is a concern for all, for this reason, the retrieval surgeon thoroughly examines all donors for evidence of any tumours or suspicious lesions. When such abnormalities are identified, a biopsy for histopathology is conducted to exclude malignancy and allows safe transplantation of organs which might otherwise be unnecessarily discarded. Work is underway in developing histopathology services to make risk-assessment and organ quality biopsies easier to obtain.