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Staff are celebrating after completing the 2,500th liver transplant at the Royal Free Hospital (RFH) since the service began in 1988.
The rate of transplantation has hugely accelerated in recent years – except during COVID-19 – and, thanks to advances in medicine, more livers, which had to be rejected, can now be harnessed. 
This is partly due to use of normothermic machine perfusion (NMP), which allows doctors to store a liver for an additional 24 hours and assess its quality before it needs to be implanted into a patient, as well as hypothermic oxygenated machine perfusion (HOPE) and normothermic regional perfusion (NRP), which both increase liver quality.
These novel machine perfusion techniques are all used at the RFH and have been used to assist more than 200 transplants at the hospital since 2019.
Despite this success the need for transplantable livers is also growing, partly due to the nation’s expanding waistlines and high alcohol consumption, both of which can result in cirrhosis – permanent scarring that ultimately damages the liver, resulting in it being unable to perform all its functions adequately.
One of the most recent people to receive a liver transplant and benefit from NMP is 68-year-old David Bland, pictured above.
David, who lives near Blandford Forum, in Dorset, went into A&E with stomach pains in 2019 and subsequently scans revealed a tumour in his liver and cirrhosis as well.
David said: “I’d been coming home every night after working long hours – I was director level running a printing company – and I’d open a bottle of wine to have with dinner and then finish the bottle. Doing that every night over the years clearly affected my liver.”
Initially David, who immediately stopped drinking after getting his cancer diagnosis, received treatment to limit the growth of the tumour and for a while it seemed that the tumour had not only stopped growing but was also shrinking.
David said: “After 850 days on the transplant list I was expecting to be told I would be coming off but instead they discovered more tumours. Nine days later I had a phone call to say they had a donor liver available and I was blue lighted into the Royal Free Hospital.”
After undergoing transplant surgery and spending a day in intensive care and nine days on a high dependency ward David was discharged home.
“Since getting home I have felt fantastic,” said David. “My energy and my appetite has come back and I’m slowly getting my strength back. I want the family of the donor to know that their actions and those of the donor have given me a new lease of life and years that I wouldn’t have had otherwise. I am very, very, very grateful.
“I also want to thank the Royal Free Hospital who have done a wonderful job. It’s just amazing how many different people and specialisms are involved. The information given to me by the consultants and the team was everything I needed and my transplant liver co-ordinator Dee was absolutely brilliant.”
David now has his heart set on a new adventure. He said: “My next plan is to buy a Jaguar and tour Europe. I can’t wait!”
Doug Thorburn, consultant hepatologist and divisional director for liver transplantation and digestive health, said: “I’m delighted to hear David is doing so well and living life to the full. I want to congratulate past and present members of the liver transplant team and all the teams that support us. We have come so far in the last 35 years but we still face a shortage of donor livers and patients still often wait a very long time on the waiting list.
“I’d also like to thank everyone for embracing the different technologies available, including the perfusion team, surgical colleagues, our transplant co-ordinators on the wards and theatre staff. This has enabled us to increase the numbers of people receiving a transplant because we have more time available to get things in place and we also have a longer time to evaluate the donor liver which helps us build a better picture of whether the liver is suitable.”
He added: “We know there is a lot more still that we can explore such as researching new portable perfusion devices and finding ways to improve the utilisation of the livers we currently have to reject. We continue to push forward with research.”
NMP and machine perfusion at the Royal Free Hospital
Rather than keeping livers on ice as is traditional, the machine mimics the human body and allows surgeons to store donor livers for up to an additional 24 hours, assessing their quality and helping more patients receive a life-saving transplant. Donor livers are kept at body temperature and pumped with oxygenated blood, medications and nutrients, to help preserve the organ.
The process is much more labour intensive, but many staff have been trained up to use the machine which is specifically used for donations after circulatory death (also known as DCD), which accounts for nearly half of all donors. Previously, the majority of DCD livers weren’t used because the lack of oxygenated blood supply meant the liver could potentially sustain some damage before transplanting.
The machine also enables more marginal livers to be used because they can be tested on the machine for suitability, instead of being instantly rejected. It also allows for more complex cases to go ahead when the maximum number of staff are available to support during the day. Even during COVID when key healthcare workers were also dealing with COVID patients, such as anaesthetists, intensivists and theatre staff, having additional time meant more transplants could go ahead.
More recently two further machine perfusion techniques have also been established at the Royal Free Hospital. HOPE allows clinicians to improve the donor liver’s quality and NRP is a technique which restores the circulation to the abdominal organs following cardiac arrest, to also help improve the liver quality. All three machine perfusion options have had a very positive affect on the number of available donor livers and their quality, leading to more patients, like David, receiving a suitable liver.
