Hello LISN members and all – and welcome to our monthly LISN journal!
It’s been a busy few weeks for LISN with many events held to both meet up and
support one another, in addition to having laughs, good food and fun days out. From the
Golf Classic to the Circle to Square Walk to coffee mornings to anniversary dinners and
the Herbie Hoedown, we’ve also been very busy raising vital funds for LISN projects. Thanks
to each and every one of you for participating or donating!!!! We sincerely appreciate
every effort to support LISN.

In the interim, I am happy to say that I have heard of two patients who received
liver transplants at St. Vincent’s University Hospital in the last few days. It is indeed
something to celebrate – one of these recipients has been waiting for over a year while
the other received a super urgent liver transplant – but let’s not forget the others who
are still waiting for their surgeries. I currently know two people awaiting the call to inform
them that a suitable donor liver has become available – that their turns have come.
While pondering on these two new recipients, I wondered how our liver transplant
rates are here in Ireland in contrast with other countries. The answer is – we are doing
very well! Here in Ireland, we currently only transplant deceased donors’ livers; the
following chart shows the number of liver transplants which took place in Ireland since
1999. Considering that St. Vincent’s University Hospital Liver Transplant programme
commenced in 1993, a lot has been achieved in 30 years!

There have been almost 1200 transplants in 30 years with the greatest number
taking place in 2019 (66) and the fewest in 2003, at less than half that at 32. While some
fluctuations are multi-factorial – mainly lack of donor liver availability – the reduction
in transplant numbers in 2020 and 2021 were very likely as a consequence of the covid-19
pandemic, particularly in the first three months, its associated lockdowns, surgery
cancellations and closures of many clinics. While the urgent need for liver transplants
remained, it is considered that the donor pool was significantly smaller due to reductions
of over 50% in donation rates.
Internationally, transplantation rates are measured per million of population so
that countries of all sizes can be compared with each other. The following chart
demonstrates deceased liver donation rates per million population in Ireland.

Internationally, we have indeed come a long way since the first, rather
unsuccessful liver transplant of 1963 by Dr. Thomas Starzl who, four years later in July
1967 in Colorado, succeeded in his aim to perform a human liver transplantation. At
present, approximately 25,000 liver transplants are being performed worldwide every year
with approximately 90% one-year survival. While this is an astonishingly impressive figure,
there are typically more patients waiting for life-saving livers than numbers receiving
transplants.
On comparing Ireland transplant rates with other countries, it is worth
considering that in Ireland there is just one modest liver transplant unit, while other
nations may have several. Furthermore, some of these nations have transplant programmes
of over 40 years, a more solid Government policy on organ donation, better public
awareness and education, focussed end-of-life carer education and extended criteria
donors which are likely to impact on donation rates, and consequently on transplant
numbers.
Let’s take a look at the Top 10 nations for deceased donor liver transplant rates,
and, not factoring in numbers of transplant centres, survival rates, the need for
retransplantation or any other variables, there is a sense that Ireland performs extremely
well for a small country with a 31-year liver transplant programme! The following chart
demonstrates where Ireland stood in 2023.

While last year was not one of our most successful, previous years including 2016
and 2019, were more positive and fruitful; shown in the following charts. It is worth noting
that there are a number of nations which remain in the Top 5 in deceased donor liver
transplant rates. The US took the lead in years 2020 to 2023 it did not accomplish the
heights that Croatia has. This country has been rated first 2012 to 2018!!!

What are the approaches that may be useful for countries with similar resource
constraints as Croatia that wish to improve their transplant systems? What is Croatia’s
secret?
Apparently, Croatian officials claim that strong central governance as well as
effective leadership at both the political (government and legislation) and clinical
(champions and key donation persons) levels are the key factors. Additionally, the act of
joining an international organ exchange scheme helped to guide the transformation
process and drive improvements in programme quality. This refers to Eurotransplant – a
network consisting of Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, the
Netherlands and Slovenia – which serves a total population of circa 139 million people.
So, on that note, please encourage friends, family, neighbours, acquaintances,
random strangers to make One Decision today! One Decision to Donate. One Decision,
many lives changed, countless waits ended, so many lives saved, endless gratitude, many
exciting tomorrows, a thousand smiles. One Decision, give life.

References
IRODaT, 2024. [https://www.irodat.org/?p=database] October 2024
Mah, J., Johnston-Webber, C., Prionas, A., Bušić , M., Streit, S., Wharton, G., Mossialos, E. and Papalois, V., 2023. Organ
Donation in Croatia: The Importance of a National Champion, a Comprehensive Plan, and International
Collaborations. Transplant International, 36, p.11011