Research themes

In support of Blood 2020, research will focus on the investigation of a number of supplementary strategies with the aim of ensuring that existing donors are able to donate as efficiently as possible. The INTERVAL study, which completed in 2016, will be key to informing future policy.

Investigation of the long-term effects of component donation has - through linkage studies - been identified as a priority. In addition, there is a need to stabilise - and if possible reverse - the decline in the donor population by better understanding motivations for donation and any factors which may be impacting on decisions to attend sessions. There will be a particular focus on donations from those with under-represented blood groups and those from Black, Asian and Minority Ethnic (BAME) communities. These priorities will be addressed through the NIHR BTRU in Donor Health and Population Genomics, delivered in partnership with the University of Cambridge.

Further areas of interest include the evaluation of non-invasive haemoglobin assessments, and investigation into dietary advice as a means of reducing deferral rates due to low levels of iron and an assessment of iron supplementation.

Understanding the epidemiology and risk associated with emerging diseases has been identified as a priority, with hepatitis E a prominent new threat. This priority will be addressed through our programme of research in transfusion/transplantation microbiology and virology to maintain blood, tissue and organ safety.

Development activities include ensuring the optimised performance of detection assays; working with Tissue Services to generate data to support a move to sample collection up to 48 hours post-mortem.

In Bacteriology, planned activities will support operations through the evaluation and validation of technologies designed to detect and reduce bacterial contamination. We will evaluate pathogen inactivation systems in collaboration with manufacturers to determine what advantages these technologies may offer.

In order to make further improvements in the management of patients who have had a blood transfusion, clinical trials are needed on the management, including the diagnosis, of acquired coagulopathy.

Acquired coagulopathy is a bleeding disorder than can affect patients in a variety of clinical settings. This area has been prioritised due to uncertainty surrounding the effectiveness of fresh frozen plasma, a significant increase in the use of cryoprecipitate in hospitals, increased off-licence use of fibrinogen concentrate and variability in practice as demonstrated in a recent national comparative audit in cardiac surgery. New guidelines in the management of major trauma also raise new questions about optimal component use in this setting.

This priority will be addressed through a clinical trial, to be run in collaboration with the Queen Mary University of London and funded by the NIHR Health Technology Assessment (HTA) (project: 15/57/02).

There is a need to continue the development of blood components (platelets and red cells) from stem cells. These have the potential to improve transfusion outcomes for specific patient groups (for example, hard to match and multi-transfused patients). In order to develop this programme of research it is necessary to understand donor factors that may affect the efficacy or safety of components. These priorities will be addressed through the NIHR BTRU in Red Blood Cell Products, which is led from the University of Bristol. Further internal investment will support a first-in-man clinical trial and parallel research activities.

The Manufacturing Development Team and Component Development Laboratories work with R&D and Operations to assess new technologies and introduce them into the blood supply chain.

In line with strategic objectives outlined in Taking Organ Transplantation to 2020, the priority is to support research that will:

1. Lead to increased rates of donation from deceased donors
2. Increase the quality and number of organs transplanted
3. Improve the longevity and quality of life of transplant recipients
4. Increase organ utilisation
5. Increase understanding of the long-term impacts of living donation.

These priorities will be primarily addressed through the NIHR BTRU at the Universities of Cambridge and Newcastle, supporting the Quality in Organ Donation (QUOD) National BioBank and developing a programme of behavioural research.

The establishment of the Research, Innovation and Novel Technologies Advisory Group (RINTAG) has provided a route for understanding current innovations and for supporting the implementation of appropriately approved and funded research, innovations and service development in organ donation and transplantation. Through horizon scanning and working with commissioners and others, this group will ensure the introduction of novel approaches aimed at improving the outcomes of patients undergoing solid organ transplantation, in line with the UK strategy Taking Organ Transplantation to 2020.

The recently approved Stem Cell Donation and Transplantation and Cellular and Molecular Therapies strategies outline our intent to maximise the number of patients who can be offered a curative stem cell transplant and our goal to establish NHSBT as the preferred provider of cell therapies to the NHS.

In Cellular and Molecular Therapies, the product development pipeline will primarily be realised through close collaboration with the NIHR BTRUs in Haematopoietic Stem Cell Transplantation and the Manufacture and Clinical Assessment of Cultured Red Cells. In the short term, technical advances in the way that services are delivered will be achieved through the provision of T-cell-depleted and virus-specific products, the provision of mesenchymal stem cells for treating steroid-resistant chronic graft-versus-host disease and the further deployment of closed processes and isolator-based processing. In Stem Cell Donation and Transplantation, the procurement of donor-derived stem cells and tissues for research and service development provides NHSBT with a unique advantage compared to other NHS and academic organisations.

In this theme, research that will provide stronger evidence for the efficacy of dCELL® Human Dermis has been identified as a priority, with the aim of increasing uptake by hospitals.

Joint funding for a clinical trial in diabetic leg ulcers has been awarded through the NIHR HTA programme. The development of further products will be considered through Tissue Services, and will be dependent upon increased revenue as outlined in the Tissues Services Strategy.

Blood Supply and Organ Donation & Transplantation (ODT) have prioritised behavioural research as a mechanism for improving blood donor recruitment and organ donation consent rates. We have therefore established a cross-cutting Donor Behaviour research strategy group that will develop a programme of research in behavioural change interventions to improve delivery of operational targets such as consent rates.

We aim to encourage academic and/or commercial partnerships with behaviour change experts in order to deliver high quality studies which will drive changes to clinical practice. 

The initial focus will be on identifying behavioural change interventions which could have a positive impact on organ donation consent rates in support of the Taking Organ Transplantation to 2020 strategy. Significant variations in consent and organ utilisation rates exist that are driven by differences in clinical practice. Adopting the best clinical practice requires evidence-based change, and we will commission a study to identify and trial behavioural change interventions that drive improvements in consent and/or utilisation rates.

This targeted research will complement existing activities led by the Marketing and Communications and ODT teams aimed at changing societal attitudes towards organ donation.

Many of NHSBT’s organisational requirements can increasingly be addressed by new tools and approaches associated with the data science revolution. Harnessing the full potential of developments requires a strategic response in two inter-related areas.

First, we will develop the personnel, expertise, and tools (for example, computing capabilities) to exploit and link our unique and complex data-sets. This will include linking our datasets to external resources being established in major international initiatives.

Second, we currently lack a systematic approach to the creation of big data resources. Our ability to combine serial access to very large numbers of donors and patients, biological samples, and consent of donors for use of their samples and e-health records for research purposes means that we have the potential to become leaders in this field. The vast amount of potential in this domain has been illustrated by the success in recent years of initiatives such as INTERVAL and QUOD.

In order to deliver these benefits, we will develop a Translational Data Science function by investing in people with the relevant quantitative inter-disciplinary expertise for building and exploiting big data resources for donor and patient benefit (e.g. bioinformatics, computational biology, statistical genomics, mathematical modelling, software engineering). To realise this goal, an options appraisal will be conducted, taking into account the government’s Strategy for UK Data Capability to establish the optimal capacity, best location, management arrangements and funding mechanism for a new translational bioinformatics and statistical genomics laboratory.