Scottish Donation and Transplant Group written update: April 2025

Tissue donation update

Update given by:

• Dr Sharon Zahra, Clinical Lead
• Mr Neil Healy, Lead Nurse – Tissues and Cells, Scottish National Blood Transfusion Service (SNBTS)

Tissue referrals

Training of the Tissue Donor Co-ordinators that were relatively recently appointed is progressing well. The team continue to engage with tissue donating hospitals to maintain awareness about tissue donation, providing training and feedback on a regular basis. 

During the last financial year there were 344 referrals for consideration of multi-tissue donation. This is comparable to the previous year where there were a total of 337 referrals for potential deceased tissue donation.

Of note the type of donor being referred appears to have changed since the coronavirus (COVID-19) pandemic, with a significant number of higher risk donors being referred, leading to a high deferral rate. There is also a trend being picked up of increased family refusals.  Work is ongoing in order to understand this better.

Tissue donation rates

Of all the deceased donor referrals in financial year 2024 to 2025, 27 deceased donors tissue donors were successfully progressed to donation. Twenty of these 27 donors donated tissue after organ donation, while the remaining seven donors donated tissue-only. These 27 donors donated 25 heart tissue products and 24 tendons. 

Donated hearts for heart tissue banking from Donation after Circulatory Death (DCD) donors are being impacted by the success of the Organ Care System (OCS) machine. In light of this NHS Blood and Transplant (NHSBT) have started to accept such hearts when the procedure is not successful so that organ transplantation of the heart does not proceed. SNBTS is currently engaging with NHSBT to ensure that the same process can be established in Scotland to ensure that no donated hearts are unnecessarily lost to clinical transplantation.

In the last financial year there were also 74 eyes retrieved by SNBTS from 37 eye donors. Discussions are ongoing to confirm the additional resource required in order for SNBTS to be able to support donor authorisation and characterisation for eye-only donors in Scotland and to also provide a seven day eye retrieval service in the central-belt of Scotland.

For the Assessment of Individualised Risk (FAIR) III changes

As previously reported the FAIR III changes were implemented for live tissue and cell donors in November 2023. Implementation of the changes for deceased donors remains on hold at the present time and discussions have continued to be progressed with NHSBT with agreement now reached as to the changes that are required to the Medical and Social History (MaSH) (questionnaire used for the assessment of all UK organ and tissue donors). The MaSH is controlled and managed by NHSBT on behalf of the UK – discussions continue to identify when the updated form can be released for routine use.

Donated skin

Donated skin is a life-saving product used to treat massive burns. Centralisation of the management of burns patient led to standardisation of clinical management and also to a significant increase in the clinical demand for skin from 147 skin packs being used in 2020 to 422 skin packs in 2023. Indeed, until last year SNBTS was responsible for ensuring a minimum stock of skin (50 packs) at all times to ensure that mass casualties can be treated at short notice. The clinical usage of skin through SNBTS however suddenly stopped with only six packs being requested in 2024. Following discussion with the plastic surgeons it transpires that the clinical team have moved away from using NHS sourced skin. As a result SNBTS is no longer responsible for maintaining a stock of skin for the treatment of mass casualties.

Pancreatic islet programme 

The SNBTS Islet Isolation laboratory continues to provide an excellent life-saving service. In the last financial year, 26 suitable pancreata were sent to SNBTS, leading to a successful islet cell product in 14 cases (54%); of these nine (35%) were successfully transplanted. 

The difference in number between successful islet products and number that were transplanted is multifactorial, including the cells not surviving an overnight hold or because the intended recipient became acutely unwell. 

The service continues to face consumables being discontinued by suppliers at short notice, needing SNBTS to continually need to identify alternative suppliers for bespoke consumables.

SNBTS is also working hard to try and identify a suitable replacement for the COBE, an essential piece of equipment required for islet cell purification. This is a worldwide issue at present. SNBTS is assessing both the Prodigy (Miltenyi) and the PRISM (Biorep) to identify whether either of these two machines are suitable for islet cell isolation. Work is ongoing to identify the necessary staffing and financial resource for this work.

Live bone donation

The bone donation rate continues to be slightly lower than the target required to meet the clinical demand. In 2024 to 2025 there were six bone donating hospitals. A total of 4487 potential bone donors were assessed, with 3218 being deferred on medical grounds and 635 potential donors were progressed to full consent and 561 of these donors successfully donated their femoral head at primary hip replacement surgery. 

At the same time 896 bones were issued to orthopaedic units in Scotland, with 615 of these being used clinically (the rest being returned to stock).

In light of the fact that the clinical demand continues to outstrip the donation rate, work is currently ongoing to onboard an additional bone donating hospital.

Reproductive tissue donation

Young patients who require treatment that is likely to render them infertile can be offered the option of storing down their reproductive (ovarian or testicular) tissue. 

This programme has been offered to patients for a number of years through SNBTS in collaboration with NHS Lothian. More recently clinical teams in NHS Greater Glasgow and Clyde and NHS Grampian have also become involved in providing the service locally to avoid patients needing to travel to NHS Lothian for the retrieval procedure. As a result, the number of patients now storing reproductive tissue has increased. The clinical feedback is that this service is expected to continue to increase significantly as it becomes routine to offer this to all relevant patients.