Skip to 0 minutes and 9 seconds PETE ASHCROFT: My name is Pete Ashcroft. I’m one of the liver transplant coordinators. We work with patients who have been referred to Birmingham for liver transplant. They undergo an assessment, they go on a waiting list, and all being well, sooner or later they have a transplant. And we see them throughout the journey, if you like.
Skip to 0 minutes and 27 seconds SPEAKER 1: Pete, can you start by explaining how you come to be introduced to the liver patients?
Skip to 0 minutes and 32 seconds PETE ASHCROFT: Yes. The patients are referred to Birmingham by their local consultants. And this may be as far afield as Liverpool or Manchester Bath, Bristol, anywhere in Wales. And they may well have been to Birmingham once or twice and seen one of the consultants here at Queen Elizabeth. And if that consultant feels that the little transparent assessment is appropriate, then they’ll be referred to us. So following that is quite a long process of assessment.
Skip to 1 minute and 4 seconds SPEAKER 1: And how are the patients when you first meet them? Are they nervous about what will happen to them?
Skip to 1 minute and 9 seconds PETE ASHCROFT: Well, I think they’re nervous, but I think, also, they’re relieved because it’s a mixture of those two really. Because they may have been ill for a long time, many years, and they see it as an opportunity to get well. And they may have had to jump over a number of– or feel as though they have had to jump over a number of hurdles to get to where they are now. So normally it’s more relief than fear I think.
Skip to 1 minute and 35 seconds SPEAKER 1: How do you explain the process of organ location to them?
Skip to 1 minute and 38 seconds PETE ASHCROFT: The patients undergo quite an extensive process of education really because we want to make sure that they understand all about their illness and about liver transplantation and the potential complications of liver transplant. And of course, before that, they’re going to wait sometimes for quite a significant amount of time before they have a transplant in fact. We simply don’t know how long they’re going to wait. Because when it comes to allocating a particular donor to a particular recipient, that’s a very complex procedure really. Because every donor is different and every recipient is different and not every donor has a perfect liver.
Skip to 2 minutes and 22 seconds But we can give some livers to some patients, but a very poorly patient would need to have a very good, although don’t like the word, quality liver, donor liver. And those don’t come along as often as, perhaps, we’d like. So the process of linking donor to recipient is very complex. It’s different every time. And therefore, we have got absolutely no idea how long the patient is going to wait before they come in for their transparent. So we try to make sure that they have a thorough understanding of that because that’s one of the most stressful things for them, not knowing when it’s going to happen.
Skip to 2 minutes and 59 seconds SPEAKER 1: How often are the patients in contact with you and how are they notified if an organ becomes available?
Skip to 3 minutes and 5 seconds PETE ASHCROFT: Well, they come to the Queen Elizabeth every four to six weeks. They see a doctor when they come. They don’t see us. We’d like to support that, but we’re not able to do so at the moment from a staffing point of view. So then they are reviewed regularly. And if they were to become more poorly whilst they waited for the transplant, then that’s going to be picked up when they come to the Queen Elizabeth for a review. Each patient– patients are given something called a UKELD score, which is an assessment of the severity of their liver disease. It looks at various parameters, sodium, bilirubin, creatinine, and blood clotting.
Skip to 3 minutes and 47 seconds And it gives them a score, and they are ranked on the waiting list according to that score. Because by definition, the higher the UKELD score, the more poorly you are, potentially the less time you have got available to wait for a liver transplant. So we essentially we break the waiting list into two sections. One we would call the priority section for the people with a high UKELD score. If people have a lower UKELD score, then that’s not quite so significant. So that part of the waiting list is ranked according to how long they’ve been waiting for their transparent.
Skip to 4 minutes and 21 seconds In this way, we hope that we’re making it fair for everybody, because obviously every patient wants a transplant as soon as possible. So we want them to understand why that might not necessarily happen.
Skip to 4 minutes and 33 seconds SPEAKER 1: Now, are you in contact with the donor coordinators?
Skip to 4 minutes and 36 seconds PETE ASHCROFT: Yes. We work closely with Janice and her team, and this happens when a donor is identified. And after Janice has done all of her work, then she will contact us. She will just ring us up, and they will offer Birmingham the liver.
Skip to 4 minutes and 57 seconds But depending on whether– that liver is not necessarily going to be accepted. It would depend on– basically, it’s reviewed by the consultant surgeon, and he would look at all of the information about the donor to decide whether he felt that was a liver that we could use in Birmingham for one of our patients. He may not necessarily do that. Almost always I guess he will, but not necessarily. And that will be discussed with the consultant surgeon, and then we’ll start to identify which patient we would want to give that particular liver to. And then we would start the process of setting up the transplant. So we don’t meet one another very often, but we do talk on the telephone.
Skip to 5 minutes and 38 seconds And quite often it’s in the dead of night.
Skip to 5 minutes and 43 seconds SPEAKER 1: So there are cases when the health of a patient may deteriorate rapidly. What happens if they become too sick to transplant? And alternatively, is there a mechanism for increasing the priority of the recipient who is getting sicker?
Skip to 5 minutes and 55 seconds PETE ASHCROFT: Yeah. As I said earlier, the UKELD score would identify if they have become more poorly. So they would be automatically prioritised on the waiting list according to that score. People do die whilst waiting for a transplant. It’s probably around about one in six patients who are added to the waiting list will not have a transparent, either because they die or they become too poorly to survive a liver transplant whilst waiting.
Skip to 6 minutes and 25 seconds SPEAKER 1: What are the most challenging and rewarding parts of your job?
Skip to 6 minutes and 29 seconds PETE ASHCROFT: I guess the most challenging is working the on-call liaising with Janice and her team
Skip to 6 minutes and 37 seconds because this furrows, happens on top of our 9:00 to 5:00 work at the Queen Elizabeth working with the patient, supporting the patient. And there are– throughout the country, there are a good many organ donor coordinators. There are other centers where organ donation takes place throughout the country, but there aren’t very many of us. So we can be very busy with a lot of offers of potential donors, not all of which come to fruition. So I guess that’s the most challenging part, really. The most rewarding part is that as a nurse, a lot of nurses work in a particular area, and they might see a patient for a short time and as soon as they get well they’re off somewhere else.
Skip to 7 minutes and 22 seconds Whereas as furrows, we have the great reward of seeing a patient when they’re very sick and they’re nervous or excited when they come to Birmingham for their assessment. And we see them throughout their entire process of waiting, we see them when we call them in for their transplant, we see them afterwards, and we see them in the liver outpatient clinic months afterwards. And the transformation in these patients is really quite remarkable from being a sick person to being a perfectly well person. And that’s quite a unique thing and very important.
Skip to 7 minutes and 57 seconds SPEAKER 1: Are there any new advances or changes in practise on the horizon that would improve the outlook for patients on the waiting list? Well, I think one of the major projects at the moment is to put the donor liver onto a profusion machine, whereby the patient’s blood is pumped through the liver on a machine which means that it keeps working. Traditionally, the method was to remove the liver and pack it was ice. And obviously when the liver is no longer receiving a blood supply, it stops working. On the machine, the livers will continue to work, and this is of great advantage to the recipient.
Skip to 8 minutes and 38 seconds One of the potential complications of a liver transplant is called primary graft non-function because a very small percentage of the livers will not restart at transplant, and they will need another transplant very quickly or they will die. So that completely takes that away, and there are other benefits too in terms of the liver continuing to work in between being removed from one person and transplanted into another. So I think that’s the most important and exciting development.
The recipient coordinator
Now we go on to meet our Recipient Coordinator Peter Ashcroft. We learn more about his role and how it differs from the experiences of Janice and the donor team.
In particular, Peter discusses his interactions with patients who require a new liver. We’ll also revisit some of the discussions around organ allocation and waiting times that we started with Dr Shetty and Dr Oo in week one Step 1.15.
Peter mentions the UKELD score again too – we’ve supplied more detail on this assessment system below. Finally, he touches on the use of perfusion devices to preserve organs. We’ll hear more about this from our surgeon Mr Perera and also in Week 3.
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