Scottish Donation and Transplant Group written update: April 2024

Written updates from the meeting of the group held on 25 April 2024.

National Organ Retrieval Service (NORS) activity update

Update given by:

  • Chris Johnston, Consultant Transplant Surgeon/NORS representative

Retrieval team activity and results

All retrievals 2023-2024 Q1 Q2 Q3 Q4 Total Annual %
DBD 15 20 18 17 70 40%
DCD 4 3 16 6 29 17%
DCD NRP 22 22 14 18 76 43%
Total retrievals 41 45 48 41 175  


DCD/NRP attendance 2023-2024 Q1 Q2 Q3 Q4 Total
DCD retrievals 4 3 16 6 29
DCD NRP retrievals 22 22 14 18 76
Total DCD donors 26 25 30 24 105
Percentage NRP attendance 85% 88% 47%




All DCD-NRPs 2023-2024 Q1 Q2 Q3 Q4 Total Annual %
Proceeding 21 20 12 16 69 91%
Non-proceeding 1 2 2 2 7 9%
Total 22 22 14 18 76  


DCD-NRP retrieval locations Attended Proceeded Proceeding %
Local 4 3 75%
Regional 57 51 90%
National 13 13 100%
Europe 2 2 100%
Total 76 69 91%

As detailed above, activity for the Edinburgh National Organ Retrieval Service (NORS) team has continued to increase, with 175 multiorgan retrievals last year, compared to a historical five year average of 150.

Normothermic Regional Perfusion (NRP) is a specialist technique used at the time of Donation after Circulatory Death (DCD) organ retrieval to re-establish an oxygenated blood supply to the abdominal organs shortly after asystole prior to organ retrieval. It allows for dynamic functional assessment of the liver ‘in situ’ and has been shown to dramatically improves outcomes of DCD liver, kidney and pancreas transplantation (reducing the DCD liver retransplant rate from 20% to 1%). The proportion of DCD donors remains high (at 60%); Edinburgh is again this year the busiest NRP team in the UK (76 NRP retrievals) and has maintained one of the lowest organ injury rates of all UK centres.

Recruitment challenges and service threats

Confirmation of funding for staffing of new and replacement positions in NHS Lothian has been very difficult over the last 12 months, amounting to effectively a recruitment freeze. Over 50% of all livers transplanted in Edinburgh over the last year involved NRP (a 6-fold increase in 4 years) and this has been achieved with less than a full complement of staff for the perfusion team (five rather than six members). With an average NRP retrieval call out lasting 15 hours, this has placed an unprecedented and unsustainable strain on the service. 

29 DCD donors were attended by the Edinburgh team without NRP last year and many other out-of-region donors that our team could have attended with NRP were not possible due to a lack of perfusion availability (500 out-of-region DCD liver offers per year; with conservative estimates that at least 50 would be suitable for liver transplantation after NRP). Our Band 7 perfusion team lead is about to move to a PhD fellowship with Edinburgh University; if a suitable replacement appointment cannot be made in the very near future, this may ultimately lead to suspension of the NRP service with an immediate considerable impact on liver transplantation activity.

Delays in recruitment across NHS Lothian are impacting the following domains:

  • perfusion service – as detailed above, a team of six perfusion specialists is required for a full-time service, this will imminently reduce to less than four full-time equivalent posts
  • consultant Transplant Surgeons – replacement of two consultant liver transplant surgeons has been delayed, placing unsustainable pressure on both the liver transplant and NRP surgeon on call rotas (more than 1 in 3 on call for surgeons contributing to both rotas)
  • transplant surgical fellows – recruitment of surgical fellows has also been delayed. The transplant service has benefited from some exceptionally talented and motivated surgical fellows over the last five years. The delay in recruitment for positions due to start in August will have an immediate impact on both retrieval and transplant impact activity, placing further strain on (currently understaffed) consultant rotas

OrganOx (NMP)

The OrganOx machine allows for a liver that has already been retrieved (possibly by another UK team) to be perfused with oxygenated blood and safely preserved for 24 hours or more. This allows for a considerable increase in transplant activity by overcoming logistics (e.g. simultaneous liver or pancreas transplant) and dynamic assessment of marginal grafts (e.g. lactate clearance on serial blood tests on the machine). It also has the capacity to increase the safety of liver transplantation by removing time pressure for the recipient hepatectomy and allowing complex transplants (e.g. redo or transplants that might require veno-venous bypass) to be performed during the day.

Edinburgh introduced OrganOx into routine clinical practice in 2019 and this capability proved invaluable in overcoming many logistical challenges during the COVID pandemic.

A meeting of consultant across all specialties involved in transplantation (liver/kidney/pancreas transplant surgeons, physicians and anaesthetists) was held in Edinburgh on 5 February 2024, with unanimous agreement across all specialist groups that OrganOx is an essential capability for the transplant unit to increase provision of liver and pancreas transplantation, and to enable safe delivery of liver transplantation for complex patients. 

Unfortunately, confirmation of ongoing funding for OrganOx has not been confirmed and this has led to an effective suspension of the service (support from OrganOx for training of new team members is pending renewal of the Edinburgh contract).


Scottish Donation and Transplant Group

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