Page last updated at 13:09 GMT, Tuesday, 24 November 2009

Organ transplants' hidden risk

By Gerry Northam
File on 4

John Richardson and his wife, Karen, hoped a heart transplant would give him a new life.

Karen and John Richardson
John Richardson never regained consciousness after his transplant

But the 37-year-old chef never regained consciousness after receiving his new heart and died five days later on 3 August 2008.

Mrs Richardson's grief was compounded when an inquest revealed a catalogue of risk factors that had impaired the heart her husband received, and the coroner recorded a verdict of death by medical misadventure.

"I know that he would have got better if he had had a good donor heart," she told BBC File on 4.

She discovered the donor had committed suicide, was a smoker with several body tattoos - creating a risk of hepatitis - and a cocaine user.

Crucially she learned it had taken 15 minutes to restart the donor's heart after he had been found hanged.

Mrs Richardson said her husband had never been told about the heart he had been going to receive and if he had known the circumstances, she does not believe he would have gone ahead with the operation.

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"There were too many factors involved to even contemplate it," she added.

The inquest also heard the donor heart had been enlarged, had had to have a hole repaired in it before transplant and that a problem had arisen during its transportation.

'Clean donors'

Steven Tsui, transplant director at Papworth Hospital, where Mr Richardson's operation was, said it had been a concern that the donor heart had stopped beating.

But he added: "We make sure at least 24 hours has elapsed before we assess these donor hearts, and in our experience... the outcome is as good as with hearts that have never suffered a cardiac arrest."

Mr Tsui also said: "When we look at donors I think we would all like to see young fit donors who are athletes with a very clean living lifestyle.

"The reality is that people with that sort of lifestyle wouldn't die very young."

It is difficult to reconcile patient choice with running an efficient transplant service
Prof John Dark, Freeman Hospital

With a national shortage of organ donors, the dilemma faced by surgeons is whether a transplant with what are called "marginal" organs from donors who could be higher risk, such as the elderly or patients with a history of cancer or drug abuse, is better than leaving a patient on a waiting list where they could die before a suitable donor can be found.

Figures disclosed to File on 4 reveal that in 1998 13% of donor organs were "marginal", 10 years later this percentage had doubled.

Everyone in the transplant field who has talked to the programme agreed the quality of organs from deceased donors was declining, accepting this meant added risks connected to the hearts, lungs, livers and kidneys used for transplants.

As one doctor put it, this is a calculated gamble.

Arising out of this comes the issue of informed consent. Who should have the final say whether an organ from a dead donor should be used, the professional or the patient?

Patient's choice

When patients join the waiting list at the Freeman Hospital, Newcastle, Professor John Dark gives them a general account of the risks of transplant surgery and the variable quality of donor organs.

Prof Dark said patients received no further information once a donor was identified because the hospital hoped the patients had enough trust in the department to give them the best organ.

Liver transplant
You have to make sure you tell the patient there's a remote possibility they could get infected otherwise you are really hiding very important information from them
Prof Nadey Hakim, Hammersmith Hospital

He added patients "know they may have the transplant cancelled because the lungs are not satisfactory in about 30% of cases".

Prof Dark said: "It is fair to say that whilst patient choice is championed in many other areas of healthcare, it's difficult to reconcile that patient choice with running an efficient transplant service."

However Professor Nadey Hakim, from Europe's largest kidney treatment centre at Hammersmith Hospital, London, believes patients have a right to know the relevant facts about the organ they could receive.

"You have to tell them because this is the minimum honesty, you have to make sure you tell the patient there's a remote possibility they could get infected, otherwise you are really hiding very important information from them," he told File on 4.

He believes it is unacceptable to say that a doctor knows best.

"We are in the 21st Century and I think if it was a member of my family, I would be very offended and upset if a member of my family is not given the choice and told exactly what can go wrong.

"I'm sorry - it is not the doctor's decision, it is the patient who has to say, 'Yes, I want it done.'"

File on 4 is on BBC Radio 4 on Tuesday, 24 November, at 2000 GMT, repeated Sunday, 29 November, at 1700 GMT. You can also listen via the BBC iPlayer after broadcast or download the podcast.

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24 Nov 09 |  Health
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