Log in
Research led by Bradley, Watson and Pettigrew (Department of Surgery, University of Cambridge) since 2000 has improved patient access to renal transplantation significantly, changed UK kidney transplant policy radically, and informed policy internationally. Their findings have increased considerably the use of kidneys (and other organs) from circulatory death donors (DCD), including those with extended time to cardio-respiratory arrest, and primary brain malignancy. Their randomised trial of machine perfusion for DCD kidneys has informed NICE guidance, while their analysis of factors that determine transplant outcome in recipients of DCD kidneys has informed national guidance for DCD kidney retrieval and organ allocation policy at NHS Blood and Transplant.
Research in the Department of Social Anthropology concerning the ethics of the use of biotechnology has had an impact on organisations with a public voice on the ethical use and regulation of body parts for reproduction and medicine, such as the Nuffield Council on Bioethics (NCOB), and indirectly the Welsh Assembly, the UK-wide Human Fertilisation and Embryology Authority (HEFA). Further, their recommendations which have been informed by this research have had significant impact on public understanding and debate; health and well-being; and on egg donors and recipients in particular. Implementation of recommendations based on the research has seen waiting times for donor eggs halve.
Professor Randhawa's research has made significant impact upon government policy and practice in relation to public engagement and professional training in the field of organ donation. The Government's Organ Donation Taskforce made 14 recommendations, one of which was to ensure organ donation was made more visible among BME communities. Subsequently, NICE Guidelines specifically referred to the need to address faith and cultural issues for families and relevant training for staff. This has informed specific national campaigns by targeting different communities and providing relevant staff training which has led to an increase in organ donor registrations from diverse communities.
This case study describes the impact of Sque's programme of research into the psychological and social concerns that impact organ/tissue donation and family members' end of life and post mortem decision-making. This work has impacted UK national policy, which guides practice and education of health professionals about the care of families who have organ donation discussed with them, and national guidance for staff responsible for care after death (last offices). It has informed public debate internationally about care of the bereaved family and how to increase the availability of organs, from deceased persons for transplants. The reach and significance of this information ranges from an international (ELPAT) and parliamentary platform to teaching volunteer service users within the University of Wolverhampton's Faculty of Education, Health and Wellbeing about the need for post mortem organ donation. This research has therefore impacted the public and healthcare professionals, locally, nationally and internationally.
This Case Study describes, inter alia, the late Professor David Price's sustained research in the broad field of organ transplantation, from which a substantial knowledge base and research expertise was developed. Its principal focus was on the availability and supply of human organs and tissue for transplantation, the continuing shortages thereof and the implications of shortfalls on quality and loss of This work has led to demonstrable policy and practice developments at national and international levels. Collaboration with policy makers, academics and health professionals across Europe has resulted in legislative developments and changes to policies and professional practice.
An 11-year programme of translational research carried out at the University of Southampton into the decision making of bereaved family members regarding organ and tissue donation has led to direct impacts on health care policy and practices. The research examined why families of the newly deceased decide for or against organ and tissue donation, and what support they need during this process. As a result, both the approach and service provided post donation to approximately 5,700 bereaved family members has changed. Findings have impacted on the training of approximately 250 specialist nurses working for National Health Service Blood and Transplant (NHS BT) and are challenging the current informational/documentary systems that are in place to facilitate donation. Findings from this extensive body of work are now embedded in NICE guidance, national clinical practice guidelines and public awareness initiatives.
Lung transplants represent the last hope for cystic fibrosis patients with end-stage lung disease. However, since the mid-1990s, other than in large research centres, some cystic fibrosis patients were not offered this treatment because of the variable and often poor outcome of surgery. This patient group carried a difficult to treat bacterial infection caused by the Burkholderia genus. In 2001 researchers in Newcastle published findings that demonstrated that one particular species, Burkholderia cenocepacia, was responsible for the poor outcomes and that other species of Burkholderia were not as dangerous. This finding was incorporated into international guidelines and since 2008 most transplant centres worldwide have adopted a risk stratification approach to listing patients for transplant. Consequently, more than 30 people per year worldwide now get transplants that would otherwise have been denied.
Kidney disease affects about 10% of the population and 10% of these patients develop established kidney failure (ERF). Transplantation is a better treatment for ERF than dialysis but is limited by acute and chronic graft rejection. Treatment of rejection mediated by the recipient's T-lymphocytes is now remarkably successful, but antibody-mediated rejection (AMR) remains challenging. A principal cause of AMR is recipient antibodies targeting human leukocyte antigen (HLA, also known a tissue type) on the transplant organ. The presence of such antibodies previously vetoed transplantation but in the last ten years it has become increasingly feasible to transplant across HLA antibody barriers. Research at the University of Warwick (UoW) by Dr Daniel Zehnder and Professor Robert Higgins has facilitated and accelerated this process. Their research includes the first detailed monitoring of antibody levels after transplantation, showing how these affect graft function, and the development of new techniques to remove antibodies from patients. This resulted in over 100 HLA-mismatched renal transplants taking place in Coventry giving a net saving to the NHS of over £5M. Their research and its clinical translation encouraged the performing of another 350 such transplants across the UK and initiation of the National Case Registry.
Research conducted by Professor Tim Goodship and co-workers at Newcastle has had a profound effect on the prognosis for patients with atypical haemolytic uraemic syndrome (aHUS). By engaging in research on the genetic factors underlying the disease they developed an understanding of the molecular mechanisms responsible. Identifying that the majority of patients with aHUS have either acquired or inherited abnormalities of the regulation of complement (part of the immune system) led to the establishment of a UK national service for genetic screening and treatment with the complement inhibitor eculizumab. As eculizumab is now available to patients in England, the progression to end-stage renal failure can be prevented and patients already on dialysis will soon be successfully transplanted.
Dr Dickinson (Bioengineering) collaborated with Professor Habib (Surgery) to develop novel methods for removing or starving tumours. Resection (removing part of an organ) is theoretically an ideal method for treating liver cancer as the liver can regenerate, but it causes extensive blood loss. The Bioengineering team developed a bipolar electrode system that employs RF current to coagulate a track in the liver; the track can then be cut without bleeding. Prototypes were successfully tested in pre-clinical and clinical trials. 20,000 single-use devices (value: US$40M) have been sold under licence by AngioDynamics, with an estimated saving of >800 lives. Complications, intensive care, blood transfusions, and hospital stay have also been dramatically reduced. Dickinson developed further bipolar devices for maintaining the patency of ducts during pancreatic and biliary cancers, for ablating liver tumours and for blocking tumour blood supply. Sold by Imperial spin-out Emcision, these are also in current clinical use.