Scottish Donation and Transplant Group written update: December 2023

Paediatric transplant activity

Update given by:

• Ben Reynolds, Consultant Paediatric Nephrologist, NHS Greater Glasgow, and Clyde

​​​​​​​It has been a relatively quiet year to date (April to December 2023), with only three transplants performed in the fiscal year so far, one deceased donor and two Living Related Donors (LRD). One LRD was deferred due to change in medical condition of the intended recipient. There are currently three patients on the Deceased Donor waiting list. It is the intention to submit one pair to the National Kidney Sharing Scheme (NKSS) in either January or April 2024 depending on condition.

For the period January to December 2023, six transplants were performed: two LRD, one Living Unrelated Donor (LURD) through NKSS and three Deceased Donor.

The deceased donor was a very unusual extended criteria donor, discussed at national meetings, and submitted for publication.

Issues

Succession and resilience planning for paediatric transplant surgeons:

Current program provided primarily by one individual with two others observing or 'doubling up' for training where possible. Only one individual would be comfortable performing transplant in our smallest patients (less than 15 kilograms) whereas most of his colleagues would be content to do larger children, certainly greater than 30-35 kilograms. Identified as a major issue in parts of England where sickness has compromised transplant services and led to organ decline or delays in transplantation.

Current surgical training does not allow any protected time for senior trainees to experience transplantation, even if they have an interest, and there is an ongoing expectation that they will contribute to the general surgical rota - or find a colleague to cover whilst a transplant is occurring. This makes training in paediatric transplantation entirely dependent on colleague goodwill, which may not be a sustainable long-term model.