Organ Donation

The history of organ donation and transplantation are inseparably entwined. Before 1960 kidney failure had a dreadful prognosis and dialysis was very crude and often dangerous. Many patients died within months of the development of kidney failure. There was no treatment for liver failure or advanced heart failure. In 1960 an act of charity between two twin brothers allowed the UK’s first successful kidney transplant to be carried out (from one brother to the other) in Edinburgh by Sir Michael Woodruff.

Following this a small number of living-donor transplants were performed between siblings. By 1965, technology had moved on and it became possible to transplant kidneys taken from people who had died under cover of new immunosuppressive drugs (which were used to prevent the rejection of transplanted organs), some of which were developed in Scotland. Over the coming years the use of organs from deceased donors became much more common and living kidney donation became a rarity.

The establishment of a robust definition of brainstem death; where the heart continues beating but the brain has died and can no longer control vital functions including breathing, improved the quality of organs and the outcomes of transplantation. As a result, kidney transplantation became accessible to patients all over Scotland. The accumulating expertise in transplantation in Scotland combined with the creation of a UK-wide organisation for matching organs provided the opportunity to extend services.

In 1992, the Scottish Liver Transplant Unit was established by Professor Sir David Carter and the first liver transplant was carried out by Professor James Garden in November of that year. Since then more than 720 patients have benefitted from a liver transplant in Scotland.

The Scottish National Heart Transplant Programme was then established in Glasgow and in 2000, the Scottish Pancreas Transplantation Programme undertook its first transplant - over 100 of which have now been performed in Edinburgh to date.

Medical care of patients with organ failure continued to improve and it became possible to keep more and more patients alive while they waited for transplants. Partly because of this, the waiting lists for transplantation lengthened and the shortage of organs for transplantation began to cause real concern. Living-donor kidney transplantation came back into regular use and around a quarter of all kidney transplants now performed in Scotland are from living donors. Scotland was awarded the first NHS-funded living-donor liver transplant programme and the first such transplant was carried out successfully in January 2008 from a woman to her husband at the Royal Infirmary of Edinburgh.

In Scotland, many patients continue to wait for transplants and a proportion die waiting. Scotland has the lowest rate of organ donation per million population in the United Kingdom.

Organ donation and transplantation is one of the strongest examples of partnerships in health between the community and the NHS. Without the generosity of the public in discussing organ donation and their families in confirming their loved one’s wish to donate, transplantation simply could not happen as it does today.

In Scotland each year some 180 patients receive a new kidney, 60 a new liver, 12 a heart and 25 a pancreas and kidney. The future development of transplantation in Scotland depends on the support of the Scottish public in backing organ donation.

Stephen J Wigmore
Professor of Transplantation Surgery

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• Organ donation
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