Patient groups involved in the Irish Donor Network (IDN) have today expressed their deep concern about the marked decline in the rates of organ donation and transplantation in Ireland between 2019 and 2020, a period that includes the onset of the COVID-19 pandemic.
The IDN further expressed deep concern that Ireland is struggling in respect of organ donation and transplantation compared with other EU28 countries*, slipping from 14th place in 2019 to 18th place in 2020 in respect of transplantation and being in 17th place for organ donation.
The IDN comprises nine patient groups concerned with organ donation and transplants in Ireland including, for example: Cystic Fibrosis Ireland; COPD Support Ireland; Cystinosis Ireland; the Irish Lung Fibrosis Association; the Irish Thoracic Society; the Irish Heart and Lung Transplant Association; and the Alpha-1 Foundation Ireland.
The network is calling on Government to undertake a range of measures to revive organ donation and transplantation in Ireland including: developing an ambitious plan to bring Ireland into the Top 10 EU countries for transplantation and organ donation; increasing investment in facilities and staffing; and enacting the Human Tissue Bill to introduce soft opt-out organ donation.
Ireland struggling on organ donation and transplants in EU28 table
The stark figures showing the marked decline are revealed in the recently published annual Council of Europe Report Newsletter Transplant 20201. Both reports from 2020 and 2019 reveal that Ireland has been struggling to keep up with many of our EU neighbours in respect of organ donation and transplant rates, even before COVID-19 severely disrupted services. IDN analysis of the figures (Annex 1) shows:
- There was a 32.1% decline in solid organ transplantation2 in Ireland in 2020 compared with 2019
- There was a 27.1% decline in deceased organ donations in Ireland in 2020 compared with 2019
- Ireland slipped to 18th place in 2020 in respect of our overall rate of all organ transplants compared with 14th place in 2019
- In 2020, Ireland was only 17th out of the EU28 countries in respect of the deceased organ donation rate, marginally up from 18th position in 2019
- The most impacted transplant programmes in Ireland in 20203 are:
– All lung transplants down 58.2% in 2020 compared with 2019
– All heart transplants down 42% in 2020 compared with 2019
– All liver transplants down 44.9% in 2020 compared with 2019
– All kidney transplants, from both living and deceased donors, are down 21.3% compared with 2019
- Pancreas transplants in Ireland bucked the overall trend and actually increased from 2019 to 2020, though the actual numbers of transplants involved are smaller (2 transplants in 2019 compared with 5 in 2020)
Range of measures proposed by IDN
In order to begin to address the current situation, the IDN is urgently calling on Government to undertake the following range of measures:
- Develop an ambitious and detailed plan to raise Ireland to the top 10 countries in the EU for transplantation and organ donation by 2025
- Urgently enact the Human Tissue Bill and soft opt-out organ donation to make more organs available for transplantation in Ireland, as per the commitments of the current and previous Programmes for Government
- Accelerate the full return of all transplant facilities used for COVID-19 (and those impacted by COVID-19) for their original transplant purpose
- Significantly increase investment in organ donation and transplantation, including an immediate organ donation and transplant ‘revitalisation fund’
- Increase investment in both pre- and post-transplant clinical care staff to address remaining gaps in services
- Allocate additional resources to ensure the change to soft opt-out is effective
- Undertake a review of the impact of COVID-19 from an organ donation and transplant perspective to ensure we learn lessons for future pandemics
Philip Watt, Chairperson, Irish Donor Network and CEO Cystic Fibrosis Ireland comments:
“The Irish Donor Network is aware that one of the key reasons for the decline in transplants in Ireland between 2019 and 2020 is that transplant resources, including clinical staff, were diverted to treat COVID-19 patients, or because transplants and assessments were paused due to facilities being adjacent to COVID-19 wards. This is likely to explain, for example, why the heart and lung transplant programme in the Mater Hospital was most disrupted by COVID-19 compared with all transplant programmes.
“A key concern is the major reduction in all transplants between 2019 and 2020 (32.1%) and the fact Ireland has slipped from 14th to 18th place in the EU in the space of one year which indicates transplant services in Ireland were hit even harder than other EU countries as a result of COVID-19.
“It’s also likely that the number of transplant assessments decreased significantly during this period, so the lengthening waiting lists for approved transplants will not give the full picture of all those who need a life-saving transplant.
“A full review and analysis need to be undertaken by Government to determine all the factors leading to these challenges, including under-resourcing of organ donation and transplant infrastructure. We are also concerned about the continuing delays in bringing in soft opt-out organ donation promised in successive Programmes for Government. While we welcome Minister Donnelly’s commitment to publish the legislation later this year, we remain worried at potential further slippage.
“These stark statistics highlight the challenge for organ donation and transplantation in Ireland. In expressing our concerns on behalf of many waiting for a transplant assessment or a life-saving transplant operation, we wish to acknowledge and thank the very dedicated clinical staff involved in organ donation and transplantation in Ireland. Clinical staff, alongside their colleagues in Organ Donation & Transplant Ireland, the HSE body that coordinates transplant and donation services in Ireland, have undertaken trojan work over the past 18 months in very difficult circumstances. In drawing attention to these figures, this is not an effort to apportion blame, rather it is an urgent ‘call for action’ for Government.”