Limits to liver transplantation in the UK

Abstract

In recent years, the number of liver transplants performed in the UK and the Republic of Ireland has been increasing by approximately 10% per year, rising from 509 in 1992 to 687 in 1995. Over the same period, the number of solid organ donors notified to the UK Transplant Support Service Authority (UKTSSA) has remained relatively static (951 in 1992, and 966 in 1995).1 In 1996, however, there was a fall in the number of liver donors for the first time, with only 691 donors accepted compared with 724 in 1995.2 3 In parallel with this decrease in organ availability, there was a 5% decline in the number of liver transplants (from 687 in 1995 down to 652 in 1996) and a corresponding 9% fall in the number of cadaveric kidneys transplanted.3 Although transplant activity has since increased (692 liver transplants in 19972), such statistics show the fragility of the current balance between solid organ availability and transplantation in the UK. Given that up to 30% of livers from potential donors are unsuitable for organ donation for medical reasons,4 the number of patients transplanted each year is unlikely to be maintained, let alone increased, unless organ availability can be improved. Although the waiting list for liver transplantation in the UK is still relatively short, it has increased by 30% over the past two years, from 138 patients on the active waiting list at the end of 1995, to 180 patients in December 1997.2 3 Median times from listing to transplantation for chronic liver disease have also risen, from 30 to 38 days in 1995/96.2 These waiting times are still much lower than those of the USA and countries in continental Europe which have a much higher prevalence of liver disease than the UK, …