Leading doctor rebukes NHS chiefs over transplant failings

A senior doctor has blamed NHS chiefs for numerous problems within transplant services in England and called for an overhaul in a leaked letter seen by the BBC.

Professor Derek Manas, the medical director of NHS Blood and Transplant, admonished NHS England for creating a system with a burnt-out workforce, "few consequences for poor performance" and operations cancelled "last-minute".

The number of heart and lung transplants the NHS carries out each year has not increased in 30 years.

NHS England, the national management body for the health service in England, said it was "working hard to improve these life-saving services".

'Unpredictable' utilising of organs

While NHS Blood and Transplant manages organ donations and supports transplant centres, services are commissioned and paid for by NHS England.

But in a letter to NHS England and a small group of patient advocates, Manas said the central body had created a "fragmented" system "with poor accountability".

There is a "mismatch", he said, between each hospital's waiting lists, organ availability, capacity to carry out surgeries and the availability of operating theatres.

This is "leading to last-minute cancellations [and] unpredictable utilisation of donated organs," he warned.

The BBC reported in March that the UK, once a world leader, had fallen behind major Western nations in heart and lung transplantation, though it fares better in other areas such as kidney transplantation.

The NHS transplants one in 10 lungs and one in seven hearts that are donated - half the proportions seen in some other countries.

It has not invested in modern technology at the same rate as other countries, and suffers from a lack of theatre space, intensive care beds and staff.

Wales and Northern Ireland do not have a heart and lung transplant centre, so patients commonly travel to England for surgery. There is one heart transplant centre in Scotland.

Waiting times for donated hearts can vary greatly - from eight months to four-and-a-half years - depending on the hospital.

Manas said NHS England had "never actively managed" waiting lists, and "seldom" tried to make it fairer.

In addition, half of the six UK heart and lung transplantation centres have lost their top surgeon in the past two years, as the medics seek opportunities abroad.

Manas said "inadequate" workforce planning had led to "burnout among transplant surgeons and teams, recruitment and retention difficulties [and] increasing reliance on goodwill. We have a system that assumes the consultant workforce will absorb pressure indefinitely."

Issues in the heart and lung transplantation service were first outlined in 2024 in a report by international experts, commissioned by the Conservative government.

NHS England, which was tasked with implementing report recommendations, said it had worked to "improve outcomes for patients", but surgeons and campaigners believe progress has been slow.

Among those who believe the system should change is Dr Zubir Ahmed, who was the health minister responsible for transplantation until he quit Sir Keir Starmer's government in May.

The Glasgow MP and kidney transplant surgeon told the BBC some elements of the transplant system were "world leading", such as being free at the point of care.

But he called for NHS Blood and Transplant to be granted the power to commission services across the UK as part of ministers' planned closure of NHS England, so that patients could be moved swiftly to get the organ they need.

"I don't think there is ever a need to cancel a transplant because of capacity issues. If we work together holistically, as a proper national system for transplantation, you could move patients around to make sure they get the organ they need," Ahmed said.

In a statement, NHS England said transplant services are "complex and impacted by many factors, including the number of organs made available for transplantation, but the NHS is working hard to improve these lifesaving services".

"NHS England is leading a programme of work which is already helping to increase the number of transplants, reduce variation, identify suitable patients earlier and improve access," it added.

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