Scope to improve organ transplant rates  

In recent weeks the HSE released preliminary figures for organ donation and transplantation in 2024.

241 transplantations were carried out in Ireland during the year (175 kidney, nine heart, 13 lung, 40 liver, and four pancreas transplantations). In addition, 22 donated organs were transplanted overseas due to there being no suitable match in Ireland. This was all made possible by the generosity of spirit of 84 deceased donors and their families, 30 living kidney donors, and the commitment and expertise of clinical staff nationally.

At any time, there are 500-600 people on transplant waiting lists, and every year some people die on these lists. It is therefore critically important that every potential donation is identified and facilitated, where this was in keeping with the individual’s wishes. These potentially life-saving donations are relatively scarce as not many people die in a manner that allows for organ donation.

The Human Tissue Act (not yet commenced into law) provides for an ‘opt-out’ system of organ donation. People who do not register to opt-out of donation will be deemed to consent, however their families will still be consulted before donation can proceed. It will remain imperative that individuals who would wish to become organ donors make this known to loved ones.

In response to the 2024 figures, the Irish Kidney Association (IKA) heralded the generosity of donors and families, and the commitment of healthcare professionals. It also noted that a national potential donor audit will, for the first time, allow for best practice to be identified and replicated and for areas that require improvement to be highlighted

However, it said the broader data indicated Ireland was losing ground rather than developing additional transplant capacity. For example, the number of people receiving dialysis in 2023 was 2,502 compared with 1,804 a decade previously. In 2023 there were 189 kidney transplants compared with 185 in 2013 (these figures include 38 living kidney donor transplants in 2013 and 30 in 2023. The HSE has previously set a goal of 50 living kidney transplants per annum).

The IKA welcomed the €2 million allocated to HSE Organ Donation and Transplant Ireland in Budget 2025, but said “more investment will be needed”. IKA CEO Ms Carol Moore emphasised the need for the requisite infrastructure, including theatre space, beds, information technology, and staff.

The IKA’s statement referenced an article published in the Medical Independent in December 2023 (‘Paucity’ of transplant infrastructure leaves services ‘vulnerable to failure’). This article reported on an internal HSE review, finalised in December 2022, which described a “paucity” of dedicated infrastructure and specialist staff for transplant services.

At the time, the HSE was finalising a strategy for organ donation and transplant services. This month, the HSE informed MI it had approved the strategy and its launch is expected in “the coming months”.

The field of transplantation has changed considerably in the past decade, with increased complexity and resourcing requirements. Many kidney donations, for example, are now from older donors with a history of more co-morbidity. Kidney transplants arising from donation after circulatory death have increased from zero in 2010 to almost 30 per cent of activity in 2023.

While outcomes for patients receiving such transplants remain excellent, this necessary evolution in organ utilisation is placing additional demands on an already under-resourced system.

Experts in the field say that sufficient  infrastructure and specialist staffing, and implementation of a potential donor audit, are key requirements to drive improvement in rates of donation and transplant.

There is clearly scope to improve. Many European countries have higher rates of transplantation than Ireland while sharing the challenge of increased medical complexity in organ utilisation (see Newsletter transplant – International figures on donation and transplantation 2023, Council of Europe/Organización Nacional de Trasplantes).

A new programme for government remains to be negotiated. A firm commitment to appropriately resource this life-saving provision would be welcomed by patients and clinicians alike.