BBC coverage of heart and lung donation and transplantation in the UK

The BBC is today covering concerns, issues and recommendations about heart and lung transplantation in the UK.

Surgeons raised concerns about the fragility of the service in the Organ Utilisation Report. The report recommended NHS England review the service. The ongoing review has included an international external expert report (PDF 1.68MB). The BBC has covered the concerns raised in these reports and reviews, along with patient and clinician interviews, and extra research. The BBC contacted NHS England, NHS Blood and Transplant, the Department of Health and Social Care, and transplant centres about the concerns.

Please find below NHS Blood and Transplant’s statement and answers to specific questions.

Statement to the BBC

There are serious concerns which have been raised and we recognise there are opportunities to improve for the benefit of patients. We have already taken steps to address this and remain committed to continuing that improvement.

NHS Blood and Transplant (NHSBT) manage the UK’s organ donation service, commissioning the National Organ Retrieval Service, supporting transplant centres, and maintaining transplant waiting lists through the UK Transplant Registry. NHS England commissions transplantation, which means it assesses, funds, plans, and monitors transplant services.

Despite significant progress, donation and transplant rates - particularly for heart and lung transplants - have not kept pace with demand.

Challenges include a smaller donor pool, changing donor demographics (more health conditions), lower family consent rates, the circumstances of death that limit who can donate, and capacity pressures in some transplant services and donor centres. We’re working hard on new research and new programmes to offer more people the chance to donate. We also need campaigns that get the nation talking about the benefits of organ donation.

The Government’s Organ Utilisation Group’s 2023 report made recommendations including for NHS England to review the heart and lung transplant service due to clinicians raising concerns about the fragility of the service. The NHSE review is ongoing and included an external expert report. We support this work and acknowledge the need to address the concerns that have been raised.

NHSBT is working with partners across the health system and learning from international best practice to address these issues. Organ transplantation is both lifesaving and life-enhancing. We all need to do more to save more lives.

Deceased donor numbers in the UK have increased by 95% since 2008
The pool of potential donors is around 18% lower than pre-pandemic levels
The average donor is now 53 years old with a BMI of 27
Family consent or authorisation rates have fallen to 59%, down from 68% before the pandemic
Total transplant rates per million population in the UK remain lower than many comparable countries, particularly for heart and lung transplants
The number of people waiting for a transplant is at the highest level ever recorded. Although this is largely driven by an increase in people waiting for kidney transplants, the is an urgent need for more donors of all kinds
The absolute numbers of both heart and lung transplants have increased since 2020/21 despite challenges in the system

BBC queries to NHS Blood and Transplant and answers

Query 1

The UK, from a position of being one of the most pioneering and world-leading nations in cardiothoracic transplantation in the 1980s, now does fewer lung and heart transplantations per population than nearly all countries in the Westen world. How do you explain this?

NHSBT response

Heart and lung transplant rates in the UK remain lower than in many other developed countries. The reasons are complex, and NHSBT works closely with DHSC, NHS England, and the wider donation and transplant community to increase transplant rates.

The UK faces particular challenges where donors are older and are likely to have more health conditions, which may make heart and lung donation less likely. By contrast, countries such as the US and Spain have younger, healthier, donor populations.

The UK’s pool of potential donors has declined since the pandemic, and family consent rates have fallen to under 60%. We’ve worked with international experts on how to increase the consent rate and we’re planning how to put that into action.

NHSBT also recognises the pressures on transplant teams, including staffing challenges and transplant surgery often being additional to routine work.

NHSBT does not commission transplants but supports the transplant community through innovation, new donation programmes, and sharing best practice. Examples include: the Clinical Lead in Organ Utilisation programme, new technology to preserve hearts from donors after circulatory death, the Organ Assessment and Recovery (ARC) pilot programme, ex-vivo lung perfusion, and initiatives using AI and genomics to improve organ assessment and matching.

Other programmes, such as Sustainability and Certainty in Organ Retrieval (SCORE), revised liver splitting criteria, and national utilisation strategies, aim to make donation and transplantation more sustainable, efficient and predictable.

We continue to learn from international systems, improve neurological death testing, explore donation through palliative care, and ensure communications emphasise the life-saving benefits of donation. Together with partners, NHSBT is committed to increasing donation and transplant rates, improving outcomes for patients, and saving lives.

Query 2

The UK declines a higher number of donated lungs and hearts than nearly all countries in the Western world. How do you explain this?

NHSBT response

Hearts and lungs are only actually donated after they have been accepted for transplant.

Decline rates also depend on which organs are offered to transplant centres. The UK offers more organs for transplant but has a particularly challenging demographic.

Donors are older, less healthy, and more likely to die from conditions which make heart and lung donation unlikely.

Countries such as America have younger donors who are less likely to have significant co-morbidities. Countries such as Spain have more assertive donation practices which may not be suitable for the public in the UK.

The latest UK data for 2024 to 2025 demonstrates a decline in the pool of potential donors, 18% lower than pre-pandemic. The average donor is also now aged 53 and has a BMI of 28.

NHSBT is also working with the subgroups set up following the Organ Utilisation Group report to further improve donation and transplant rates.

Query 3

Surgeons who have worked in the UK have told us that their capacity to provide the best service to patients has been held back by a lack of investment.

They say that the lack of a coronary angiogram as standard means the UK is failing to assess the suitability of donor hearts, and that surgeons may consequently implant diseased hearts with a lesser lifespan.

They say that the continued use of an ice box means hearts are more prone to primary graft dysfunction. This, they say, can lead to patients requiring more intensive care support, which is costly, inefficient and stops centres treating more patients.

How do you respond to this? What steps have you taken to rectify such issues?

NHSBT response

We support the expansion of diagnostic tests including coronary angiograms where it is an appropriate investigation for a donor with an appropriate risk factor. There are risks and benefits to invasive angiograms.

Through the Clinical Lead in Organ Utilisation scheme we are looking at other options for assessing hearts to try and provide more information for recipient teams and improve patient outcomes.

Hospitals have traditionally used ice boxes for heart preservation because they are a simple, widely available method for transporting organs - this is no different to the rest of the world. NHSBT is rolling out advanced organ preservation technologies and carrying out a trial to safely expand this to heart and lung donation, alongside updated clinical guidance and training to improve organ quality, patient outcomes, and the efficiency of heart transplants, helping centres treat more patients safely.

Query 4

There is a significant difference in the waiting list times between UK centres for routine cardiothoracic transplant patients. What steps have you taken to reduce the waiting list times for the centres with the highest wait times?

NHSBT response

Donation and transplantation make up a relatively small part of the NHS’s specialist clinical procedures, so local or temporary pressures - such as elective surgery or cancer waiting times - can have a large impact on how individual trusts prioritise these services. The reasons for variability are complex and include differences in recipient profiles between centres. For example, one of the potential explanations for differences in waiting times for non-urgent heart transplant may have related to access to DCD heart donors (whilst the programme was developed these organs were utilised by the centres developing the programme). With the collaborative working that has now led to the world leading National DCD Programme, we would hope to see these differences diminish.

NHSBT does not commission transplant services but supports the system by providing policies, best-practice guidance, data, and tools. Clinical decisions remain with transplant centres. NHSBT publishes detailed, centre-specific transplant data and works with hospital trusts to improve equity and efficiency, including developing a points-based scheme for heart and lung transplants and supporting standardisation, collaboration, and use of ‘organ utilisation’ meetings.

Greater visibility of transplant activity at board level and sharing of best practice will help trusts strategically allocate resources, overcome barriers, and reduce inequities in access. NHSBT continues to work with regulators and commissioners to promote best practice and improve outcomes for patients.

Query 5

There is variation in the 5-year mortality statistics between centres for adult lung patients. What are you doing to raise the performance of the centres with the highest mortality rates?

NHSBT response

NHSBT does not commission transplantation and therefore has limited authority. We collect data and publicly publish centre specific statistics including outcomes. These statistics are also shared with organ specific advisory groups, which include representatives of all transplant centres. We share these statistics with NHSE at the annual clinical meeting and highlight outliers. We also write letters to clinical directors about the donation and transplant activity at their trust.

Additionally, NHSBT monitors short-term patient outcomes following organ transplantation through centre specific cumulative sum (CUSUM) analyses. These ‘within centre’ analyses enable prompt detection of any changes in failure and mortality rates, providing external assurance and enabling centres to compare current outcomes with their own past performance to assist in internal auditing.

If CUSUM monitoring reports on mortality and graft failure detects a signal, then this is reported back to the centre and a detailed report is required, which is reviewed and assessed by an expert panel. If systemic issues are identified an incentre face to face review is carried out by the expert panel and recommendations are put in place to effect change. The trust management is also notified and engaged with.

NHSBT supports an OUG recommendation that that there needs to be greater visibility of the impact of transplant services at trust board level. Evidence from the clinical panels and online survey of clinical teams highlighted the importance of visibility of activity at the Trust Board level.

Query 6

In 2023, the Implementation Steering Group for Organ Utilisation was established. We have been told progression has been too slow, with little meaningful difference. What steps have you taken in this time? What evidence do you have to show they have improved patient outcomes?

NHSBT response

NHSBT has worked to implement the elements of the strategy for which they are directly responsible, for example the introduction of organ Assessment and Recovery Centres, establishment of collaboratives, ensure strategies to empower patients are put in place, ensure trust engagement strategies are delivered through provision of data to trust boards, and strengthening commissioning of transplant services in collaboration with NHSE by creating the Transplant Oversight Group and the national Transplant Clinical panel to monitor quality, risk and emerging issues across the transplant pathway. We are partners in the ongoing work of all the implementation subgroups.

Several of the actions are for other organisations. For example, the Cardiothoracic transformation program is an NHSE responsibility which we are supporting through the NHSBT Cardiothoracic Advisory Group. NHSE has said the strategy was purposefully ambitious, and it was anticipated that it would take 10 years to deliver.

Query 7

We understand that the UK may be the only Western nation that does not prioritise children for transplants, in cases where a donor heart may be used in either a child or an adult. Do you agree with this approach?

NHSBT response

Hearts from paediatric donors are prioritised for paediatric patients. There are many different offering schemes throughout the world. Whilst some of these prioritise adult donors for paediatric recipients, not all of them do.

Like the majority of countries, we prioritise patients based on clinical need. Hearts need to be matched by blood group, size and travel time. The allocation policy has been to prioritise paediatric donor hearts for paediatric patients and adult donor hearts for adult patients. There is no perfect allocation system - the shortage of suitable donor hearts means unfortunately some patients will not receive a transplant in time. A 2025 working party led by transplant clinicians with patient partners has recommended that we move towards a new, points-based system, to improve offering of hearts for all recipients (paediatric and adult). The new allocation system is being finalised. The biggest challenge is the shortage of suitable donors, particularly the shortage of donated hearts from younger and smaller children.

Query 8

Why hasn’t opt out delivered more organ donors?

NHSBT response

The deemed consent legislation is not the silver bullet to closing the gap between donation and transplantation, rather it is an important piece of the whole jigsaw to improving organ donation, transplant, and consent rates.

Surveys show lower public awareness of donation and higher levels of distrust in the NHS since the pandemic. This is also increased inertia, with many people believing they do not need to take any action. Transplant need has also increased by more than a third since 2020.

We support:

More targeted communication to key groups who are underrepresented on the UK Organ Donor Register (e.g. over 50 yrs, lower socio-economic groups, Black heritage and ethnic minorities) through campaigns, partnerships, and building on the work of Organ Donation Committees and Community Grants Programme partners.

Broad disruptive communication approach that gets the nation talking, making donation less taboo.

Our submission to the NHS 10-year plan include includes making donation a mandatory part of the school curriculum.

Ensuring that every family who is in a position to make a donation decision is able to speak with a Specialist Nurse in Organ Donation, so that any decision is informed.

Query 9

What about patient outcomes, are they worse?

NHSBT response

NHSBT analysed long-term patient outcomes for adult and paediatric heart transplants . The analysis showed UK outcomes were equivalent or better than those published by the International Society for Heart & Lung Transplantation (ISHLT).

This analysis shows that the overall UK median survival time following adult heart transplantation is 13.5 years for transplants performed during 2001-2006. The ISHLT report a median of 12.5 years for transplants performed between 2002-2009.

For paediatric heart recipients, the overall UK median survival time is 24.8 year for transplants performed during 1996-2016. However, for transplants performed during 1996-2001 it is 15.4 years which compares to a median of 14.6 years reported by the ISHLT for transplants performed between 1992-2001.

For adult lung recipients, the UK median survival is 6.2 years for transplants performed during 2001-2006. The ISHLT report a median of 6.5 years for transplants performed between 2002-2009.