Living organ donation

Living organ donation
UK Parliament POST Research Briefing 27 April 2021

• This POSTnote describes the scale and nature of living donation in the UK, its regulatory framework and the ethical considerations around this highly regulated procedure. It also analyses challenges within living organ donation, and the strategies implemented to address them.

Quality and safety of human organs, tissues and cells

Guidance: Quality and safety of human organs, tissues and cells

DHSC 31 December 2020

• Guidance for hospitals, tissue establishments and fertility clinics for ensuring the quality and safety of human organs, tissues and cells (including reproductive cells).

NICE COVID-19 rapid guidelines

COVID-19 rapid reviews of interest to Specialised commissioning
NICE 
Check NICE website for new guidelines and updates

• COVID-19 rapid guideline: haematopoietic stem cell transplantation (NG164) 1 April 2020 Updated 10 February 2021
• COVID-19 rapid guideline: delivery of systemic anticancer treatments (NG161) 20 March 2020 Updated 12 February 2021
• COVID-19 rapid guideline: dialysis service delivery (NG160) updated 11 September 2020
• COVID-19 rapid guideline: critical care in adults (NG159) updated: 12 February 2021
• COVID 19 rapid guideline: renal transplantation (NG178) 19 June 2020 updated 19 August 2020
• COVID-19 rapid guideline: arranging planned care in hospitals and diagnostic services
  NICE guideline [NG179] 27 July 2020
  
  • The purpose of this guideline is to help healthcare professionals deliver efficient planned care while minimising the risk of COVID-19 in the context of increasing or decreasing local prevalence. It also aims to help patients make decisions about their planned care. It is for adults, young people and children in hospitals and diagnostic settings.
• COVID-19 rapid guideline: delivery of radiotherapy (NG162) 28 March 2020 updated 12 february 2021
• COVID-19 rapid guideline: cystic fibrosis (NG170) 09 April 2020 updated 7 October 2020
• COVID-19 rapid guideline: interstitial lung disease (NG177) 15 May 2020

Normothermic Machine Perfusion could make more livers available for transplant

A new technique could make more livers available for transplant
NIHR Alert 2 October 2020

• Researchers have studied a technique called Normothermic Machine Perfusion (NMP) which keeps blood flowing through the liver while it is outside the body. The liver is preserved in a near real-life condition while it is assessed for transplant. 
• The new trial, called VITTAL, showed that many livers which had been rejected by surgeons could be transplanted successfully into patients. This is a step forward in making more livers available for transplantation.
• The full paper: Mirza DF, and others. Transplantation of discarded livers following viability testing with normothermic machine perfusion. Nature Communications, 2020;11:2939

Adult liver transplantation: A UK clinical guideline

Adult liver transplantation: A UK clinical guideline
British Society of Gastroenterology 4 April 2020

• Part 1 of this guideline has dealt with all aspects of liver transplantation up to the point of placement on the waiting list. Part 2 explains the organ allocation process, organ donation and organ type and how this influences the choice of recipient.

Frailty in lung transplantation: a systematic review

Frailty in lung transplantation: a systematic review
Expert Review of Respiratory Medicine, 19 December 2020, 14:2, 219-27, DOI: 10.1080/17476348.2020.1702527

• This article reviews the current literature on frailty in lung transplantation, with an emphasis on frailty measures, prevalence and impact of frailty on morbidity and mortality prior to and following lung transplantation. It concludes that frailty is identified often in lung transplant candidates and is associated with adverse pre and post-transplantation outcomes. Further research is necessary to identify potential frailty interventions.

Abstract

UK Guidelines on Pancreas and Islet Transplantation

UK Guidelines on Pancreas and Islet Transplantation
British Transplantation Society September 2019

• These guidelines cover solid organ pancreas transplantation and allogeneic islets of Langerhans transplantation, but exclude islet autotransplantation. Includes a Summary Table of Outcome Measures in simultaneous pancreas-kidney transplantation.

Caring for People with Liver Disease including Liver Transplantation: a Competence Framework for Nursing

Caring for People with Liver Disease including Liver Transplantation: a Competence Framework for Nursing

Royal College of Nursing 18 September 2019

• This updated framework describes the professional standards expected of practitioners when caring for people with liver disease including liver transplantation. It is designed to support practitioners in a clear, consistent and evidence-based format to reflect their specialist knowledge and skills. This edition includes competencies for liver transplantation.

Graft Rejection Prediction Following Kidney Transplantation Using Machine Learning Techniques: A Systematic Review and Meta-Analysis

Graft Rejection Prediction Following Kidney Transplantation Using Machine Learning Techniques: A Systematic Review and Meta-Analysis
MEDINFO 2019: Health and Wellbeing e-Networks for All, Studies in Health Technology and Informatics Volume 264: p10 - 14. DOI 10.3233/SHTI190173

• Analysis of the literature around the role of machine learning (ML) in predicting graft rejection following kidney transplantation identified 14 studies and five different algorithms.

Abstract

Hand and Upper Limb Transplant Service (Adults)

Hand and Upper Limb Transplant Service (Adults)
NHS England 24 July 2019

• Service specification. 

A pathway for post-transplant care

A pathway for post-transplant care
Anthony Nolan May 2019

• A post-transplant care pathway has been developed by Anthony Nolan under the leadership of an Expert Steering Group for patients who have had stem cell transplants.
• The pathway consists of five main building blocks: (1) throughout recovery, (2) preparation for transplant, (3) early post-transplant care, (4) ongoing prevention and monitoring, and (5) additional treatment and support.

Establishing a tele-clinic service for kidney transplant recipients through a patient-codesigned quality improvement project

Establishing a tele-clinic service for kidney transplant recipients through a patient-codesigned quality improvement project.
BMJ Open Qual 2019;8:e000427. 8 April 2019. doi: 10.1136/bmjoq-2018-000427

• Findings from a pilot tele-clinic (telephone consultation) service for kidney transplant patients attending North Bristol NHS Trust Renal Unit shows that they are deliverable and well received by patients with a positive environmental impact and modest financial savings. 
• "It has the potential to be rolled out to other renal centres if a national tele-clinic tariff can be negotiated, and an integrated, appropriately reimbursed community phlebotomy system can be developed to facilitate remote monitoring of patients."

Abstract

Ex-situ machine perfusion for extracorporeal preservation of livers for transplantation

Ex-situ machine perfusion for extracorporeal preservation of livers for transplantation [IPG636]
NICE Interventional procedures guidance, January 2019

• Evidence-based recommendations on ex-situ machine perfusion for extracorporeal preservation of livers for transplantation in people of all ages. This involves using a machine to give an oxygenated solution to the donor liver until it is transplanted.

Specialised commissioning prioritisation results – June 2018

Specialised commissioning prioritisation results – June 2018
NHS England 7 July 2018

• A list of the latest innovative new treatments approved by NHS England. Non drug innovations include:
• Left Atrial Appendage Occlusion for patients with atrial fibrillation and relative or absolute contraindications to anticoagulation (adults)
• Selective dorsal rhizotomy
• Total pancreatectomy with islet transplantation for chronic pancreatitis

Robot-assisted kidney transplant [IPG609]

Robot-assisted kidney transplant [IPG609]
NICE April 2018

• This Interventional Procedures Guidance (IPG) concludes that current evidence on the safety and efficacy of robot-assisted kidney transplant is limited in quantity and quality. It presents recommendations in relation to patients with obesity, and patients for whom open kidney transplant surgery is suitable. 
• The procedure should only be done by teams of surgeons with experience in both transplant surgery and robotic surgery.

The Royal Free Hospital 'hub and spoke network model' delivers effective care and increased access to liver transplantation.

The Royal Free Hospital 'hub and spoke network model' delivers effective care and increased access to liver transplantation. [Abstract]
Public Health. 2018 Jan;154:164-171. doi: 10.1016/j.puhe.2017.10.012.

• A retrospective evaluation of outcomes and patient satisfaction within the Royal Free liver transplant 'hub-and-spoke' network concludes that the networks are effective in offering equivalent clinical outcomes, high patient satisfaction and alleviate clinical pressure on the hub centre. They have to potential to help eliminate the geographical disparity in mortality rates from chronic liver disease.