The National Organ Retrieval Service (NORS) at Cardiff and Vale University Health Board (UHB) has successfully used a pioneering technique to retrieve organs including a liver originally declined by other centres due to poor function.
One of the first teams in the UK to use innovative Normothermic Regional Perfusion (NRP), the Cardiff NORS team successfully retrieved abdominal organs from two donors. The organs were successfully transplanted in different centres across the UK. Five lives were saved as a result, including four kidney recipients and one liver recipient.
The liver had originally been declined by all transplant centres in the UK due to its poor function but with NRP technology, the liver was reconditioned and subsequently accepted and transplanted into a patient in need of an urgent liver transplant.
Cardiff is now one of few centres in the UK running an independent NRP programme alongside Cambridge and Edinburgh and it’s hoped the new technology will allow Cardiff and Vale UHB to retrieve more organs that would have otherwise been declined.
How does it work?
The NRP is a revolutionary retrieval technique specifically used to procure organs from donors after circulatory death (also known as DCD donors).
The NRP technology reconditions organs by circulating oxygenated blood through the abdominal organs by blood pump before they are removed from a DCD donor. Essentially, recharging the organs for the transplant recipient.
Why is this important?
Over the last decade, the rapid expansion of the Donation after Circulatory Death (DCD) donor pool in the UK has led to the significant increase in organ transplantation.
However, following a cardiac arrest the hypoxia (lack of oxygen supply to the organs) can cause organ injury and result in low quality organs and lower number of organs retrieved for transplantation.
This process reconditions and improves the quality of organs and overall transplant outcomes. It also enables the retrieval team to assess organ quality before transplantation.
Additionally, this surgical technique is slower and safer, lowering the risk of surgical damage to the organs retrieved.
Elijah Ablorsu, Consultant Transplant Surgeon and Clinical Lead for Organ Retrieval, who set up NRP program in Cardiff and led the team in achieving the first two NRP retrievals, said: “This technique helps to recondition organs potentially damaged by ischaemia (restriction of blood supply to an organ) during circulatory death that subsequently improved outcomes of transplantation.”
Mr Ablorsu was appointed as a consultant at Cardiff and Vale University Health Board in 2010 and has helped establish one of the top performing retrieval teams in the country.
“This is a huge accomplishment to set up a new and unique programme during the pandemic and places Cardiff amongst leading retrieval and transplant units in the UK,” he added.
“This technique will be used to retrieve organs from all DCD donors and helps to increase the number of transplants, improving the outcomes of transplantations.”
Three surgeons and two scrub practitioners who are part of NORS team at Cardiff and Vale UHB are now fully qualified in NRP retrievals.
Consultant Transplant Surgeon, Mr Laszlo Szabo, one of the certified NRP surgeons involved in the first two NRP retrievals, said: “It was a great achievement for us to be the first to achieve this and learn from the Cambridge and Edinburgh teams who have pioneered the NRP programme in the UK.
“This technology improves the quality of the organs retrieved and helps the transplanting surgeons to select the suitable organs for transplantation. By allowing us to see the recovery status of the organs, we can more confidently decide whether to transplant an organ into a recipient.
“This technique will allow us to retrieve more organs that otherwise would have been previously declined and therefore not accepted for transplant. As this evolves, it will mean being able to carry out more transplants in the future. For the donors, the technology is helping to honour their decision to donate their organs to save someone’s life.”
The NRP team were required to undertake a comprehensive training program, the majority of which was taken during the height of the COVID-19 pandemic and frequently outside of the staff’s usual working hours. The team also had to undergo a validation and approval process before receiving authorisation to open the NRP programme.
Alex Croose, Scrub and NRP Practitioner in Cardiff and Vale UHB’s NORS, said: “We did our best to ensure that the programme could go ahead, even throughout stressful and uncertain times. It wasn’t an easy thing to accomplish.
“The pandemic impacted many services and people, causing a great deal of stress on everyone’s lives. For us, as a team it was challenging to carry on with the training because we were redeployed and utilised in different areas due to our skill set.
“We put in every effort where we possibly could, even reading protocols at home or in the back of an ambulance whilst being on call. It was well worth the push to get the training complete.
“The NRP programme is so important. By enabling the organ to recover back to its optimum level it’s ensuring that the organ recipient is getting the best possible organ, giving them the best chance of a new life. This is truly amazing for the donor also, who’s given the gift of life and for the Recipients.”
This achievement could only happen due to the dedication and commitment of the team and Cardiff Transplant Unit, with the support of Cardiff and Vale University health Board and Welsh Government.
The team at Cardiff and Vale UHB has received credit from NHS Blood and Transplant for achieving this milestone.
Image: stock image of surgeons operating