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Overview
Royal Papworth Hospital's heart and lung transplant programme is the biggest and most experienced unit in the country, treating patients from across the United Kingdom. Teams here perform approximately 90 adult heart, lung and heart-lung transplants each year, including about 50% of the UK's cardiothoracic DCD activity.
The team cares for around 1,000 transplant recipients and also retrieves cardiothoracic organs for other UK centres.
In 2020/21, despite the pressures of the COVID-19 pandemic, 37 heart transplants and 19 lung transplants were performed at Royal Papworth Hospital, which is roughly two-thirds of the activity in a normal year.
The transplant team also implant Ventricular Assist Devices which act as a bridge for some patients on the heart transplant waiting list.
Cardiothoracic transplantation
Royal Papworth Hospital is the country's main adult heart and lung transplant centre and has carried out a number of UK, European and world first transplants since the UK's first successful heart transplant operation by Sir Terence English in 1979. It is also a world-leader in DCD heart transplantation.
Since then, almost 3,000 heart, lung and heart-lung transplants have been carried out by the hospital, with world-leading survival rates, the shortest waiting lists and an increasing number of patients living 30+ years post-transplant.
Teams at Royal Papworth have conducted the most heart transplants every year in the UK since 2008/09 and is the most active adult cardiothoracic transplant programme. In 2020/21, the hospital performed 56 transplants which was more than any other UK centre, with survival rates consistently above the national average.
The hospital has also pioneered the use of invasive monitoring and hormone resuscitation for managing multi-organ donors which has become the international gold standard in donor management.
I’m beyond grateful that my donor had expressed their wish to become a donor after death and shared their feelings with their family. That decision and conversation has allowed me to be alive today.
Camilla
Heart transplant recipient
Innovation: UK, European and world firsts
In 1979, Royal Papworth Hospital performed the UK's first successful heart transplant. This was followed five years later by the first successful heart-lung tranplant in the UK and the world's first heart-lung and liver transplant in 1986.
In 2015 a team at Royal Papworth Hospital became the first in Europe to successfully perform a transplant using a non-beating heart from a circulatory determined dead (DCD) donor. Up until then our transplant team were only able to transplant hearts from donors following the diagnosis of brain-stem death (DBD).
The transplant team at Royal Papworth Hospital took this one step further when, in June 2019, the world's first DCD heart-lung operation was performed on a 24-year-old patient.
View a full timeline of the history of transplantation at Royal Papworth Hospital.
DCD heart transplants
Royal Papworth Hospital is a world-leader in DCD heart transplantation, having performed the first in Europe in 2015 and more than any other centre worldwide.
Donation after circulatory death (DCD) refers to the retrieval of organs for the purpose of transplantation from patients whose death is diagnosed and confirmed using cardio-respiratory criteria. Essentially, their heart has stopped beating and is no longer circulating blood around the body following the planned withdrawal of life-sustaining treatments.
Previously, all transplants were after brain-stem death (DBD); a person's heart is still beating but they no longer have any brain functions and will not be able to breathe without mechanical support.
In October 2018, Royal Papworth Hospital's DCD heart transplant operation was used on the 50th patient. It continues to be the biggest such programme in the world with 100 transplants now performed and in 2019/20 accounted for 50% of the hospital's heart transplant activity.
Now in its sixth year, short and mid-term survival via the DCD method at Royal Papworth Hospital is comparable to DBD heart transplants with similar length of stay in intensive care and total stay in hospital post-transplant.
Read more in The Journal of Heart and Lung Transplantation - '5-Year Single Centre Early Experience of Heart Transplantation From Donation After Circulatory Determined Death (DCD) Donors'.
Fran Middleton received a DCD heart transplant at Royal Papworth Hospital in 2018
UK heart and lung transplant activity report 2020/21
NHS Blood and Transplant's national organ and tissue donation and transplantation activity report 2020/21 was published in July 2021. The report lists a number of highlights for Royal Papworth Hospital:
- We performed the most heart transplants (37) of any UK centre.
- We performed the most cardiothoracic transplants (56) of any UK centre, making us the UK's biggest cardiothoracic transplant unit.
- Of those, 17 were DCD transplants (11 hearts and six lungs). There were a total of 36 cardiothoracic DCD transplants in the UK, meaning Royal Papworth Hospital was responsible for nearly 50% of DCD activity.
However, NHS Blood and Transplant's annual report on cardiothoracic organ transplantation shows that the number of patients on both the heart transplant waiting list (340) and the lung transplant waiting list (346) is at an all-time high nationally, which means that demand is rising. At three years after being listed for a routine heart transplant in the UK, only 17% of patients have been called in from home for a transplant. This is 47% for lung transplant patients, which shows there continues to be an unmet need.
If you would like to be an organ donor, please join the organ donation register and communicate your decision with your family. You could save up to nine lives.
Mechanical devices
Royal Papworth Hospital has a long history of innovation in heart and lung transplantation and has been using mechanical circulatory support devices to treat patients with end-stage heart failure since the 1980s.
Sometimes, very sick heart failure patients require bridging therapy before transplantation. This can be through the insertion of a mechanical blood pump known as a ventricular assist device (VAD). This can be to assist the left ventricle of the heart (LVAD) or both ventricles (BiVAD).
Patients fitted with a LVAD can be independent within the community while waiting for a suitable donor heart, but patients on BiVADs stay as an inpatient in our critical care unit until they are matched with a suitable donor heart.
Patient referrals
Patients are referred to the service by their local GP. The transplant physicians decide if the patient would be suitable for an outpatient and/or inpatient assessment. It is usual for a family member to accompany the patient on these visits. A range of planned tests are carried out and the process culminates in a multidisciplinary team meeting which discusses the options for each individual patient and makes recommendations for their future care. These options are then discussed with the patient.
Useful resources
Life with an LVAD
Luis shares his experience of having a Left Ventricular Assist Device (LVAD) followed by a donation after circulatory donation (DCD) heart.
Luis received a DCD heart transplant at Royal Papworth Hospital in 2016
Writing to your donor family
Sarah, Chrissy, Katie and Bianca from our transplant link team talk you through the dos and don'ts when it comes to writing to your donor family.