Ireland’s Transplant History
Background
The first liver transplants in Ireland were performed on paediatric recipients in Our Lady’s Hospital for Sick Children, Crumlin in the mid-1980s. Despite initial success, numbers were too low to sustain a paediatric programme and patients have since then been referred to King’s College Hospital in London.
Liver transplantation is now performed in only one publicly funded hospital in the state, St. Vincent’s University Hospital, Dublin. The National Liver Transplant Programme was launched there in January 1993, with the 30-year anniversary of the programme celebrated in October 2023.
The development of the programme in Ireland was phased over several years and included an initial two-year liaison with King’s College Hospital in London, where a fully developed programme in liver transplantation was in place. During this period, all members of the future Irish transplant team – medical, nursing and paramedical – spent time training in liver transplantation at King’s College Hospital. The links with King’s College Hospital have been maintained over the years to provide a second opinion for complex cases and there is also an arrangement for organ sharing for super-urgent transplants.
Funding for liver transplantation
The state, through the Health Services Executive (HSE), funds the liver transplant service. There is no private provision, and costs related to liver transplant are not covered by private health insurance in Ireland. All hospital-based costs are covered by the government for all patients. Following transplant, high-cost immunosuppressive drugs are prescribed using the high-tech prescription scheme.
Current demands for donor livers and some indications for liver transplant
Over the past two decades, demand for liver transplants have steadily increased. Currently, circa 60 liver transplants are performed annually. At the present time, demand exceeds donor supply although the imbalance is less marked than in most Western countries. Median time on the waiting list has risen. Demand is driven by an increasing incidence of alcoholic liver disease, hepatitis C virus (HCV), and non-alcoholic fatty liver disease. Despite popular stereotypes, alcoholic liver disease was not a major health problem in Ireland until relatively recently. Hospital admission rates for alcoholic liver disease tripled between 1994 and 2007, although they now appear to be plateauing. There is also a large cohort of patients infected with HCV, mainly due to intravenous drug abuse.
Some rare and atypical indications for liver treatment and / or transplant in Ireland include genetic haemochromatosis and paracetamol overdose. Ireland currently has the highest rate of paracetamol-induced liver failure than much of Europe.
Organ Donation in Ireland
Attitudes to organ donation among the general public in Ireland are very positive. The number of donor livers varies between 60 and 80 per year and has been relatively stable over the past 20 years. However, given that the population of the Republic has increased by 30% over that time period, this represents a fall in donation rates.
With the enactment of the Human Tissue (Transplantation, Post-Mortem, Anatomical Examination and Public Display) Act, 2024 on 26th February, it is anticipated that the soft opt-out approach to organ donation from deceased donors will increase the donor pool. While the provision of a robust, transparent and ethical legal framework for the removal, donation and use of organs from deceased persons for the purposes of transplantation is a very welcome endeavour, donation rates will only increase in tandem with further commitments by the Department of Health. Educational campaigns and the provision of more clarity on this system must be provided, in addition to a continuous commitment to research and innovation, infrastructural investments and expansion of transplant centres, intensive staff training, expanded criteria for organ donation, the presence of transplant coordination teams in ICU settings and a more donation-focused approach by end-of-life carers.
There are currently no plans for a living donor programme for liver donation; this has the potential to increase donation rates in some cases.
Be a donor
With higher transplant rates representing more lives saved and countless grateful families and friends, making time to discuss your donation wishes with your next-of-kin is just so important. Remember you are five times more likely to need a transplant than to become an organ donor – donate life!
Iqbal, M., Elrayah, E.A., Traynor, O. and McCormick, P.A., 2016. Liver transplantation in Ireland. Liver Transplantation, 22(7), pp.1014-1018.
