2 Overview of Organ Donation and Transplantation Overview of Organ Donation and Transplantation A summary of organ donation and transplantation activity in the UK during the financial year from 1 April 2014 to 31 March 2015-3 -
2.1 Summary of activity The total number of deceased donors and transplants fell this year for the first time in 11 years. The number of patients on the active transplant list at 31 March 2015 is 83 fewer than on the same date last year. This drop reflects an increasing number of transplants performed over the last 10 years, and a reasonably steady number of patients joining the transplant list each year. In the most recent year there have been fewer transplants but an increasing number of patients have been suspended from the transplant list. Donor and transplant numbers (1 April 2005 to 31 March 2015) and the number of patients registered on the transplant lists at 31 March each year are shown in Figure 2.1. There were 169 fewer deceased donor transplants in 2014-2015 than in the previous year, representing a 5% decrease. The corresponding decrease in the number of deceased donors was 3%. Figure 2.1 Number of deceased donors and transplants in the UK, 1 April 2005-31 March 2015, and patients on the active transplant list at 31 March 9000 8000 7000 6000 6681 7224 7658 7887 8012 7814 7645 7335 7026 6943 Number 5000 4000 3000 2000 2197 2386 2384 2559 2655 2706 Donors Transplants Transplant list 2916 3118 3508 3339 1000 765 793 809 899 959 1010 1088 1212 1320 1282 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 Year - 4 -
Figure 2.2 shows the number of deceased and living donors during 2005-2015. The number of deceased organ donors in the UK remained stable over a number of years but following the implementation of the Organ Donation Taskforce recommendations in 2008, the numbers rose. This increase has continued for 6 years until this year when there has been a slight fall in donor numbers. There have been 1,050 to 1,150 living donors each year in the last 6 years. Compared with last year s high, there was a 5% fall to 1,092 living donors this year. Figure 2.2 Number of deceased and living donors in the UK, 1 April 2005-31 March 2015 1200 DBD donors DCD donors Living donors 1062 1046 1055 1101 1147 1092 1000 961 858 800 780 772 702 705 Number 600 637 599 634 609 611 624 637 652 507 540 510 436 400 288 335 373 200 128 159 200 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 Year Figure 2.3 shows the potential deceased organ donor population in the UK. Not everyone can be a deceased organ donor and this figure highlights the small proportion of deaths in the UK that represent potential donors. Please note that the information presented comes from several different sources. The NHSBT Potential Donor Audit, collects information on most but not all actual donors and the potential for donation could therefore be slightly underestimated. The quoted numbers of transplants and organs transplanted are those achieved using organs from deceased actual donors in the UK, some of which may have been performed overseas, and does not reflect the number of deceased donor transplants in the UK, which may have used organs from overseas donors. - 5 -
Figure 2.3 UK potential deceased organ donor population, 1 April 2014 31 March 2015 UK population 1 ~64,000,000 UK deaths 2 ~576,000 Deaths in hospitals 3 ~ 287,000 Potential donors 4,5 7,450 Eligible donors 4,6 5,636 Donation requests 4 3,295 Consented donors 7 1,923 Actual donors 7 1,282 Transplants 7,8 3,322 Organs transplanted 7,8 3,736 1 Mid 2013 estimates: www.ons.gov.uk 2 2013 data: England & Wales www.ons.gov.uk; Scotland www.gro-scotland.gov.uk; Northern Ireland www.nisra.gov.uk 3 2013 data: England & Wales www.ons.gov.uk; Scotland www.isdscotland.org; Northern Ireland www.nisra.gov.uk 4 2014/2015 data: NHSBT, Potential Donor Audit 5 Potential donor - patients for whom death was confirmed following neurological tests or patients who had treatment withdrawn and death was anticipated within four hours 6 Eligible donor - Potential donor with no absolute medical contraindications to solid organ donation 7 2014/2015 deceased donor data: NHSBT, UK Transplant Registry 8 Using organs from actual donors in the UK Table 2.1 shows the number of deceased donors and transplants in 2014-2015 and patients on the transplant list at 31 March 2015 for each country in the UK. - 6 -
Table 2.1 Deceased donors and transplants 1 April 2014-31 March 2015, and transplant lists as at 31 March 2015, by Country of residence Country of residence¹ England Wales Scotland Northern Ireland Organ N (pmp) N (pmp) N (pmp) N (pmp) Kidney Deceased donors 992 (18.4) 64 (20.8) 94 (17.6) 48 (26.2) Transplants 2,3 1611 (29.9) 66 (21.4) 153 (28.7) 44 (24.0) Transplant list 4927 (91.5) 159 (51.6) 442 (82.9) 141 (77.0) Pancreas Deceased donors 378 (7.0) 26 (8.4) 41 (7.7) 16 (8.7) Transplants 2 184 (3.4) 17 (5.5) 20 (3.8) 3 (1.6) Transplant list 175 (3.2) 11 (3.6) 24 (4.5) 6 (3.3) Heart Deceased donors 144 (2.7) 6 (1.9) 19 (3.6) 4 (2.2) Transplants 2 155 (2.9) 7 (2.3) 16 (3.0) 0 (0.0) Transplant list 239 (4.4) 13 (4.2) 13 (2.4) 8 (4.4) Lung Deceased donors 172 (3.2) 6 (1.9) 16 (3.0) 9 (4.9) Transplants 2 160 (3.0) 9 (2.9) 8 (1.5) 7 (3.8) Transplant list 270 (5.0) 23 (7.5) 26 (4.9) 12 (6.6) Liver Deceased donors 755 (14.0) 55 (17.9) 77 (14.4) 32 (17.5) Transplants 2 664 (12.3) 28 (9.1) 103 (19.3) 25 (13.7) Transplant list 494 (9.2) 22 (7.1) 52 (9.8) 21 (11.5) Intestinal Deceased donors 19 (0.4) 1 (0.3) 1 (0.2) 0 (0.0) Transplants 2 21 (0.4) 1 (0.3) 0 (0.0) 0 (0.0) Transplant list 8 (0.1) 0 (0.0) 0 (0.0) 0 (0.0) Total Deceased donors 1060 (19.7) 71 (23.1) 97 (18.2) 48 (26.2) Transplants 2 2795 (51.9) 128 (41.6) 300 (56.3) 79 (43.2) Transplant list 5941 (110.3) 221 (71.8) 550 (103.2) 179 (97.8) 1 Excludes patients residing in Channel Islands, Isle of Man, overseas and in the Republic of Ireland 2 Deceased donor transplants 3 Kidney only transplants - 7 -
2.2 Transplant list At 31 March 2015, 6,943 patients were registered for an organ transplant in the UK on the active transplant list. A further 3,375 patients were temporarily suspended from the active national transplant list because they were unfit or otherwise unavailable for transplant. Details of numbers of patients on each of the organ transplant lists are given in Table 2.2 for 31 March 2014 and 2015. Between these dates, the total number fell by 83 patients (1%) due to decreases in the number of patients on the kidney, pancreas and intestinal transplant lists. Table 2.2 Active transplant lists in the UK at 31 March 2014 and 2015 2014 2015 % Change Kidney & pancreas patients 5932 5720-4 Kidney 5663 5468-3 Kidney & pancreas 201 201 0 Pancreas 35 15-57 Pancreas islets 33 36 +9 Cardiothoracic patients 531 599 +13 Heart 245 262 +7 Heart/lung 15 13-13 Lung(s) 271 324 +20 Liver patients 531 596 +12 Intestinal patients 13 9 - Other multi-organ patients 1 19 19 0 ALL PATIENTS 7026 6943-1 Percentages not reported when fewer than 10 in either year 1 Includes patients waiting for kidney and liver transplants (16 in 2014, 13 in 2015), kidney and heart transplants (1 in 2014, 4 in 2015), liver and lung transplants (1 in 2014, 1 in 2015), liver and pancreas transplants (1 in 2014), liver and heart transplants (1 in 2015) During 2014-2015, 429 patients died whilst active/suspended on the transplant list. This information is shown by organ in Table 2.3. - 8 -
Table 2.3 Number of patient deaths on transplant lists in the UK, 1 April 2014 and 31 March 2015 Kidney & pancreas patients 269 Kidney 243 Kidney & pancreas 26 Pancreas 0 Cardiothoracic patients 79 Heart 34 Heart/lung 4 Lung 41 Liver patients 80 Intestinal patients 1 ALL PATIENTS 429 2.3 Transplants There was a 5% fall in the total number of organ transplants (from deceased and living donors) last year: 4,431 transplants were performed in 2014-2015 compared with 4,655 in 2013-2014 (Table 2.4). All multi-organ transplants are identified separately as are transplants from living donors. There was a 5% fall in total organ transplants last year. The fall was seen across the organs although DBD kidney transplantation increased by 1% and there were small increases in the number of DBD pancreas, DCD lungs and livers and living donor liver lobes. The greatest increase was in the number of DCD kidney and pancreas transplants (57%). - 9 -
Table 2.4 Transplants performed in the UK, 1 April 2013-31 March 2015 Transplant 2013-2014 2014-2015 % Change DBD kidney 1156 1163 +1 DCD kidney 784 717-9 Living donor kidney 1115 1052-6 DBD Kidney & pancreas 153 118-23 DCD Kidney & pancreas 35 55 +57 DBD Pancreas 22 24 +9 DCD Pancreas 4 5 - Pancreas islets 32 23-28 Deceased heart 1 197 180-9 Heart/lung 8 1 - DBD Single lung 27 17-37 DCD Single lung 5 6 - DBD Double lung 148 128-14 DCD Double lung 30 34 +13 DBD liver 582 563-3 DCD liver 151 176 +17 Domino liver 4 2 - DBD liver lobe 135 87-36 DCD liver lobe 0 1 - Living donor liver lobe 28 38 +36 Bowel only 2 11 6 - Liver, bowel & pancreas 2 3 - Multivisceral 3 10 11 +10 Modified multivisceral 3 4 - Kidney & heart 1 1 - Kidney & liver 12 14 +17 Liver & pancreas 0 1 - Lung & kidney 0 1 - TOTAL ORGAN TRANSPLANTS 4655 4431-5 Total kidney transplants 4 3257 3122-4 Total pancreas transplants 4 261 244-7 Total cardiothoracic transplants 416 368-12 Total liver transplants 4 924 896-3 Total intestinal transplants 26 24-8 Percentage not reported when fewer than 10 in either year 1 Including DCD heart (1 in 2013-2014, 1 in 2014-2015) 2 Including a kidney (1 in 2013-2014) 3 Including a kidney (1 in 2014-2015) 4 Includes intestinal transplants - 10 -
The total approximate number of patients with a functioning transplant in the UK on 31 March 2015 is 47,100 (Table 2.5). This reflects information held on the UK transplant registry database and excludes those patients who are known to be lost to follow-up. Table 2.5 Number of transplants reported as functioning at 31 March 2015 Functioning transplants 1 Kidney 32700 Pancreas 1900 Cardiothoracic 3700 Liver 8700 Intestinal 100 ALL PATIENTS² 47100 1 Approximate number being followed up ² Number of patients with a functioning transplant Multi-organ transplants (excluding intestinal transplants) are counted in each organ Excludes those patients known to be lost to follow-up - 11 -