Progress in transplantation, organ donation and research

On 23 April, a collection of researchers, medical professionals, patients and members of the general public congregated at the Royal Free Hospital for an afternoon of enlightenment and discussion.

The Rt Hon. Adrian Bailey MP opened the conference, revealing that three people die each day in the UK waiting for an organ transplant. This highlighted the importance of the situation, explaining why the shortfall in donor organs needs to be addressed urgently.

Session 1: Pathway of Transplantation, Donation and Research
Professor Brian Davidson (UCL Division of Surgery and Interventional Science) was tasked with providing “a brief history of transplantation, organ donation and research”. He managed to offer a comprehensive overview, focusing on the dramatic improvements in organ transplantation since the 1970s.

Professor Davidson was clear, however, that there are still necessary advancements to be made. He mentioned the disparity between donation rates across Europe – the rate in the UK is half that of Spain.

Possible solutions to bridge the gap were explored, such as surgical innovation (splitting donor organs and live donor transplants), xenotransplantation and tissue engineering.

Another possible solution, using donors after cardiac death (DCD), increases the donor pool, but using such organs results in worse outcomes. Professor Davidson commented that such measures are “maintaining the supply of organ donations – but at a significant cost”.

In conclusion, he listed challenges for the future, including: reducing or eradicating the use of immunosuppressant drugs, reducing the risk to live donors and reducing organ damage during transport.

The next speaker, Dr Sarah Hosgood, addressed the issue of “maintaining organ viability after donation until transplantation”. She discussed the positive effect that “pre-conditioning” can have on the donated organ, a process that attempts to improve the viability of DCD organs by re-heating them briefly before transplantation.

Victoria Marshment from the Human Tissue Authority proceeded to give a legal and regulatory view on organ transplantation and research. The main focus of her summary was the difficulties with the licensing restrictions set out in the Human Tissue Act 2004 (HTA) that makes removal of organs for research difficult.

Session 2: Human Tissue Research from Bench to Bedside
Dr Tahera Ansari began the next session with an explanation of what exactly an engineered organ is, explaining that the uses of engineered tissue are to repair, restore, replace and regenerate.

After illustrating various successes that have occurred using engineered tissue, she went on to suggest that this may be a way to address the donor shortage and the goal to reduce the use of immunosuppressant drugs, due to their side effects.

Dr Jonathan Fishman (UCL Institute of Child Health) offered a more specialist example from his own work on the larynx. He discussed a patient called Brenda Jensen, who received the second larynx allotransplant in the world – an operation involving UCL’s Professor Martin Birchall.

“So many of our dreams, at first, seem impossible, then they seem improbable, and then, when we summon the will, they soon become inevitable” – a quote by Christopher Reeve that Dr Fishman used to illustrate his opinion that we are currently at the improbable stage. He hinted that engineered tissue usage in transplants will become inevitable.

Session 3: Safer, Better and Quicker Delivery of Treatments Towards Stratified (personalised) Medicine
Jacki Trafford from AbCellute discussed the use of human tissue during therapy development in relation to the HTA 2004 – which again involved highlighting the difficulties it has created.

She moved on to suggest some of the impacts of this: researchers are moving out of the UK or sourcing tissue from outside the UK, research is being halted, and consequently, the British economy is suffering.

Dr David Bunton from Biopta presented the argument for human tissue research in the drug approval process. He highlighted multiple case studies where animal experimentation had been insufficient or even misleading.

He explained that many clinical trials failed because of these inconsistencies, and argued that earlier human tissue testing may have a place in improving this situation.

Christian Brailsford from NHS Blood & Transplant explained that organs retrieved for transplantation, but later deemed unsuitable, could be hugely helpful if used for research. But again, he alluded to the difficulties with this under the HTA 2004.

Session 4 and Session 5: Future Research Possibilities
Interactive question and answer sessions followed the talks. Firstly, the audience were asked to identify themselves, for example: general public, patient, hospital doctor and researcher.

The most popular group was healthcare researchers– perhaps unsurprisingly – but, interestingly (and encouragingly), the second most prevalent group was those who represented the public.

The audience were then asked to consider questions that were pinned up around the room, then to write their answer and pin it to the board. This was a way to encourage the audience to think about their personal opinions; it also encouraged broader conversations within the audience, but also with the speakers.

Using interactive handsets, various speakers then posed questions relating to general opinions, whether the conference had changed any opinions and some questions relating to future research.

Image: Brenda Jensen.

Jessica Lowrie is an intern in UCL Communications & Marketing.

Links:
Tissue Access for Patient Benefit