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Kidney Health 2020

The amazing progress of kidney transplants

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Interview with Professor Vassilios Papalois

Consultant Renal Transplant Surgeon

Medical advancements in treating kidney failure now mean organs that were previously rejected can instead be improved, increasing the number and improving the outcomes of kidney transplants.

As our population ages there are certain conditions that become more prevalent than others. One of these is chronic kidney disease, which has two main causes: diabetes and high blood pressure.

Kidney dialysis comes with many limitations and challenges. According to Professor Vassilios Papalois, Consultant Renal Transplant Surgeon, transplants offer better outcomes and increase patients’ life expectancy significantly. He said, “As surgeons we constantly strive to think outside the box when it comes to giving medical care. Dialysis means a constant interruption to daily habits including work and family, but with a successful transplant, life can once again be lived to the full.”

While the demand for donation still outstrips the amount of viable organs, the upcoming ‘opt-out’ organ donation changes and the ability to monitor and assess organs to ensure that they become viable should see more successful transplants, more often.

Advancements in organ care

Previously, organ donation from deceased donors has followed a strict set of criteria, but now hospitals such as Imperial College Healthcare NHS Trust’s Renal and Transplant Centre at Hammersmith Hospital can receive organs from donors who may have been discounted by guidelines in the past, and improve organs that may not have been considered viable before.

Professor Papalois explains, “Kidney transplants have evolved massively over the last decade. At our Trust, we pioneered machine perfusion in the UK, where an organ can be preserved in a better way than in cold storage. We can now accept organs that were previously considered ‘high risk’, assess their condition and even improve them before they are transplanted.”

Another major advancement in the field of kidney transplantation has been the development of kidney transplants from living donors. Hammersmith Hospital has one of the largest living-donor kidney transplant programmes in Europe carrying out 70-80 live kidney transplants per year, and offers a pathway not just for high-risk cases, but also pre-emptive transplants that can happen before a patient needs dialysis.

Challenges in recruiting donors

The criteria surrounding donations has been dramatically expanded over the last few years. Patients can receive donations from either a suitable deceased donor or a living donor thanks to techniques that have been developed by pioneering trusts such as Imperial College Healthcare NHS Trust.

With support from specialist organ donation nurses and living donor co-ordinators, there has been a dramatic change in culture for patients and their families, as well as healthcare professionals, in favour of donation and transplantation.

Professor Papalois hopes that with the start of the opt-out donor programme in Spring 2020, which will consider all UK adults organ donors unless they declare otherwise, conversations around donations will become more frequent and more transparent.

He says, “I have worked for the NHS for over 25 years so I know that the biggest challenge is changing the understanding of organ donations and transplants with patients and colleagues. We still have a big gap in donors but I know that with the advances we are introducing, if we can overcome this we will have a spectacular outcome.”

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