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A leading figure in the NHS transplant sector, Professor Derek Manas, has sharply criticized NHS England for systemic issues affecting organ transplant services across the country. In a confidential letter reviewed by the BBC, Manas, who serves as the medical director of NHS Blood and Transplant, highlighted how the current system results in a workforce suffering from burnout, a lack of accountability for poor performance, and frequent last-minute cancellations of vital operations. Notably, the number of heart and lung transplants performed annually by the NHS has remained stagnant for three decades.
NHS Blood and Transplant oversees organ donation management and supports transplant centres, but the commissioning and funding responsibilities lie with NHS England. Professor Manas pointed out that this arrangement has led to a fragmented system characterized by insufficient accountability. He explained there is a considerable imbalance between hospital waiting lists, organ availability, surgical capacity, and access to operating theatres, causing unpredictable usage of donated organs and last-minute surgery cancellations. Furthermore, the UK, which was once a leading nation in heart and lung transplantation, now lags behind other Western countries, despite performing relatively well in kidney transplants. This shortfall is partly due to underinvestment in modern technology and a shortage of theatre space, intensive care beds, and specialized staff.
The variation in waiting times for heart transplants is marked, with patients at some hospitals facing waits as long as four and a half years, while others wait only eight months. Professor Manas criticized NHS England’s management of waiting lists, stating they have never actively tried to balance these to ensure fairness. Within the past two years, half of the UK’s six heart and lung transplant centres have lost key surgeons to opportunities abroad. According to Manas, poor workforce planning has contributed to burnout among specialist surgeons and their teams, accompanied by recruitment and retention challenges, alongside a growing dependence on goodwill. A report compiled by international experts in 2024 and commissioned by the Conservative government first exposed these transplant service issues. Although NHS England has been working to implement the report’s recommendations and improve patient outcomes, such progress is considered slow by many clinicians and campaigners.
Dr Zubir Ahmed, a former health minister responsible for transplant services until his resignation from the current government in May, also advocates for reform. The Glasgow MP and kidney transplant surgeon acknowledged that some components of the transplant system remain “world leading,” especially in its provision of care without cost at the point of delivery. However, he proposed that NHS Blood and Transplant should be empowered to commission transplant services UK-wide, potentially replacing NHS England’s role as part of broader ministerial plans. This change would facilitate quicker patient transfers when organs become available. He emphasized, “I don’t think there is ever a need to cancel a transplant because of capacity issues.” NHS England responded, affirming the complexities of transplant services and ongoing efforts to enhance the number of transplants, reduce regional disparities, identify suitable patients earlier, and improve access to these lifesaving procedures
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