Surgeon shortage hits transplants

TRANSPLANT SURGERY has lost its glamour and its future is threatened by a shortage of donor organs and growing disaffection among young surgeons, specialists said yesterday.

Despite advances that have made transplantation the best treatment for most patients whose organs have failed, the supply of organs is declining and the specialty is facing a crisis, the Royal College of Surgeons warned.

The work has made Sir Magdi Yacoub, the heart transplant pioneer, an international celebrity, but new surgeons are put off by the heavy demands, which include frequent all night and weekend operating.

Sir Peter Morris, professor of surgery at Oxford University, who chaired a college working party on the problem, said: "The provision of organ transplantation as a service is on a knife edge. It is not seen as glamorous or as exciting as it was 20 years ago."

Almost 1,500 organs taken from 900 donors were transplanted in 1997 but there are more than 4,500 patients on the waiting list. Demand for organs is rising at over 3 per cent a year but the supply is falling. Fewer people die in road accidents, a big source of organs, which are down by more than a third since the early 1980s because of safer cars and roads, and fewer die of brain haemorrhages caused by stroke, down 57 per cent since 1976, because of improved medical care.

The working party report, published yesterday, calls for a doubling in registered donors, from 5 to 10 million. Sir Peter said: "We would like to see organ donation discussed within families and by the public so it becomes part of the culture. When a loved one dies the family will then ask automatically for the organs to be used."

The increased use of living donors, who can give one kidney or a part of their liver, could also go "a long way" to solving the shortage, he said. That practice has grown in Sweden and the United States. However, the idea of an "opt out" scheme, under which people would be presumed to have consented to the removal of their organs after death, unless they had registered their opposition, was rejected. "That is a decision the public have to make," Sir Peter said.

Most organ transplants are carried out as emergencies after hours because of the shortage of operating theatre time and because the organs will not keep.

Robert Bosner, a cardiac transplant surgeon from Birmingham, said 98 per cent of heart and lung transplants were carried out after midnight. "There are 300 heart transplants a year and 10 to 20 per cent die on the waiting list," he said. However, thousands more could benefit from transplants if more organs and surgeons were available.

The report says transplants should be concentrated in 20 hospitals, rather than the present 28, to ensure expertise is maintained and no surgeon is on call more than one night in four, rather than every other night.

There are 67 kidney transplant surgeons, 21 short of the total needed to cope with the existing workload on a one in four rota, and 22 liver transplant surgeons, 15 short of the number needed. "Consultant positions need to be made more attractive," Sir Peter said.