Scottish Donation and Transplant Group written update: April 2024

Paediatric transplant activity update

Update given by:

• submitted by Ben Reynolds, Consultant Paediatric Nephrologist

The number of transplants in 2023/24 has been lower than anticipated, with one deceased donor and three living related donors.

There have been zero deceased donor transplants since May 2023 and the Royal Hospital for Children (RHC) has not received a single deceased donation offer since that time. The change in the organ allocation scheme in 2019 was expected to disadvantage children by a small number of months in overall wait time. The modelled numbers were disrupted by the COVID-19 pandemic and NHS Blood and Transplant (NHSBT) have repeatedly stated that they do not anticipate a significant impact on children. 

However, we currently have one Tier A patient (with a matchability score of ten) and one child who has been on dialysis for six and a half years, and a couple more who have been actively listed for several years. This has been reported back to the Kidney Advisory Group (KAG) of NHSBT but not yet actively actioned, to my understanding.

Surgical sustainability

UK-wide, there have been disruptions in the delivery of paediatric transplantation as there have been centres without availability of a suitably trained surgeon. The concept of mutual aid (one English centre either providing facilities or a surgical team at the time of transplant offer) is being actively pursued amongst some English centres. 

Here in Scotland, the paediatric program has the support of four paediatric urologists, and several adult transplant surgeons though the vast majority are undertaken by a single surgeon. There are efforts to ensure that there is slack within the system in case of individual illness. However, training within transplantation for junior surgical trainees remains a point of contention (currently any observation of transplantation will usually be done at the goodwill of the trainee, for example by swapping shifts so that they can attend). This does not represent a sustainable approach.