World-famous heart transplant hospital given the all-clear

Nov 20 2007

World-famous Papworth hospital in Cambridgeshire, England, has been given the all-clear to resume heart transplant surgery.

The all clear follows a two week investigation by the Healthcare Commission after 7 of 20 transplant patients died between January and September, all within 30 days of surgery; an eighth patient critically ill at the time of the inquiry, also died later.

The Healthcare Commission report which was requested by the hospital, says further investigation is needed to clearly explain the increased death rate, but as long as its 12 recommendations are implemented, surgery can recommence.

The team, led by Nigel Ellis, found only one consistent factor in all the deaths and that was a rise in the time taken to transport hearts from one hospital to another; when hearts are without blood the start to deteriorate.

The report says the risk of a transplant death rises after 180 minutes, and "exponentially" after 240 minutes, and in all the deaths, this "ischaemic" time was more than 180 minutes.

Dr. Steven Tsui, Papworth's clinical director for transplant services, says this was not unusual and the average ischaemic time of those who die is always greater than those who do not die and is something they have been trying to reduce.

Dr. Tsui says there have been more than 1,000 heart transplants carried out at Papworth and in that context, the recent deaths constitute a relatively small number.

Ellis says no evidence of inadequate care or evidence that the deaths could have been prevented was found, but the number of deaths since January has clearly been high.

The hospital has been asked implement a number of important checks and safeguards in order to ensure that everything possible is being done to protect heart transplant patients, including how they assess patients with regard to suitability for surgery.

Papworth has been asked to make procedures for preserving hearts "in line with practice at other trusts", but Tsui, himself a transplant surgeon, who has welcomed the recommendations, says the hospital is not out of line.

The report says heart transplants have changed, possibly because of seat-belt legislation which dramatically cut the number of young people dying in road accidents who were suitable donors.

While the report says this was not a factor at Papworth, Ellis and his team believe it is an issue which might need to be addressed in the future as transplant centres have been forced to relax the criteria and are now using hearts which may not have previously been considered acceptable.

Dr. Tsui says a very severe shortage of donors limits how many heart transplants can be done and the rate at Papworth is the lowest for 20 years.

Tsui says the need was not just to legislate so organs could be taken from anybody who had not explicitly refused beforehand, this is now the subject of a government review, but culturally, as a nation, Britain has to decide whether to embrace transplantation and organ donation.

Dr. Tsui says it takes public education to make people realise how important and life-saving the issue is.

Stephen Bridge the Chief Executive of Papworth Hospital says the hospital welcomes the report and is prepared to embrace all its recommendations, many of which endorse the procedures already have in place.