The House will remember that, under this Government, Max and Keira’s law was introduced—a law that garnered all-party support—changing the legal basis of consent for organ donation to one of deemed consent, commonly referred to as “opt out”. At that time the Government committed to 700 additional transplants per year which reflected the overwhelming support of the population in helping others, after death, through the gift of organ donation. Following this legislation, the Government set up the Organ Utilisation Group (OUG) under the expert chairmanship of Professor Sir Steve Powis to deliver improvements in the number of organs that are accepted and utilised for successful transplant in adult and paediatric patients.
The House can be justly proud of the role that British clinicians and scientists have played in the history of successful transplantation. But not many realise that this leadership continues today, particularly in the field of new methods of organ preservation and perfusion. The OUG heard evidence that described the importance of continued support to maintain that leadership status both for patients in the United Kingdom and across the globe.
The Government also wish to pay tribute to patient groups, individual patients and their carers who gave time and consideration to significant engagement with the work of the OUG. It is clear the output of the report has benefited from this engagement to a significant extent.
The Government welcome the 12 recommendations in the report and note that many of these do not require extra resource; they simply need a different way of working, with increased collaboration across organisations that deliver the service. I am confident that the recommendations will give benefits to those in need of a transplant with the aim that all patients should have fair and equitable access to transplant services regardless of their background or heritage or where they live in the country.
I also wish to recognise the donation and transplant teams across the country for their hard work during the pandemic. Their use of new collaborative processes has enabled people at the end of life who wished to donate to have these wishes honoured, and those patients who desperately needed a transplant to have that procedure performed, often through night-time surgery. Recommendations in the report also address the need for a robust and sustainable service that acknowledges this round-the-clock vital activity.
The OUG heard evidence from national and international stakeholders, which led to the following themes and recommendations. Each recommendation is accompanied by supporting actions to inform implementation.
Theme 1: Placing the patient at the heart of the service
Recommendation 1: Patients who are being considered for transplantation, referral or listing must be supported and have equal access to services irrespective of their personal circumstances including ethnic, geographical, socio-economic status or sex.
Recommendation 2: Transplant services must be run with reference to patient feedback, including frequent opportunities to listen and act on views from less heard voices.
Theme 2: An operational infrastructure that maximises transplant potential
Recommendation 3: Standardised patient pathways must be developed and made available for each organ type, with well-defined timescales for each stage of the pathway. Data available for each stage of the pathway informs monitoring against best practice. Clinical leads for utilisation support the review of the data, to identify and drive local improvement initiatives.
Recommendation 4: Transplant units must build on the lessons learned during the covid-19 pandemic and increase further the collaborative effort across units.
Recommendation 5: NHS England must undertake a comprehensive review of cardiothoracic services to ensure that services in place are sufficiently sustainable and resilient and are able to provide the best possible outcome for patients.
Theme 3: Creating a sustainable workforce that is fit for the future
Recommendation 6: A national transplant workforce template must be developed to provide definitions of the skill mix for an effective, safe and resilient transplant workforce that is fit for current and future demands.
Theme 4: Data provision that informs decisions and drives improvements
Recommendation 7: The provision of data must be transformed, using digital approaches to provide access to complete, accurate and standardised data and information to everyone who needs it at critical decision points throughout the donation to transplantation pathway.
Theme 5: Driving and supporting innovation
Recommendation 8: National multi-organ centres for organ assessment and repair prior to transplantation must be established to provide the optimum practical steps to bring new techniques into everyday clinical therapy as rapidly as possible, to maximise the number and quality of organs available for transplant and support logistics at transplant units.
Recommendation 9: A national oversight system must be established that makes the best use of the UK’s world leading innovation in assessment, perfusion and preservation of donated organs.
Theme 6: Delivering improvements through new strategic and commissioning frameworks
Recommendation 10: All NHS trusts with a transplant programme must have a transplant utilisation strategy to maximise organ utilisation.
Recommendation 11: National measurable outcomes must be defined and agreed in order to prioritise, monitor and evaluate the success of key strategies, tools and processes.
Recommendation 12: Robust commissioning frameworks must be in place, with well-defined roles and responsibilities of the various agencies involved in organ transplantation, particularly focusing on the relationship between NHS Blood and Transport and commissioners. Memorandums of understanding (MoUs) across the agencies must be created to formalise the process for the joint commissioning of transplant services.
The Government are grateful to Professor Sir Steve Powis and all the members and observers of the OUG. We have committed to an implementation oversight group that will be led by the Department of Health and Social Care, working with expert stakeholders in organ utilisation to drive forward implementation of the recommendations.
The House will remember many heartfelt and emotional interventions from members across all parties at the time when Max and Keira’s law was passed. The recommendations in this report follow up on that important change in our legislation and, once properly implemented, will increase transplants for patients in desperate need of donated organs and tissues wherever it is safe to do so.