Senior Doctor Rebukes NHS Leaders Over Transplant System Failures

Professor Derek Manas, the medical director of NHS Blood and Transplant, has sent a strongly worded letter to NHS England and a small group of patient advocates sharply criticising the management of transplant services in England. The letter, seen by the BBC, accuses NHS England of creating a fragmented system characterised by poor accountability, a burnt-out workforce and operations cancelled at the last minute.

System Failing Patients

Manas described a fundamental mismatch between each hospital's waiting lists, the availability of donated organs, surgical capacity and the availability of operating theatres. This is leading to last-minute cancellations and unpredictable use of donated organs — a waste of a life-saving resource. The number of heart and lung transplants carried out by the NHS each year has not increased in 30 years. Compared with some other countries, the NHS transplants only one in ten donated lungs and one in seven donated hearts — roughly half the proportions achieved elsewhere. Waiting times for a donated heart vary dramatically depending on which hospital a patient is treated at, ranging from eight months to four and a half years.

Workforce Under Pressure

Half of the six UK heart and lung transplant centres have lost their leading surgeon in the past two years, with experienced professionals seeking better opportunities abroad. Manas warned that inadequate workforce planning has resulted in burnout among transplant surgeons and teams, persistent recruitment and retention difficulties, and increasing reliance on staff goodwill. "We have a system that assumes the consultant workforce will absorb pressure indefinitely," he wrote. Wales and Northern Ireland have no heart and lung transplant centre, meaning patients must travel to England for surgery. Scotland has one such centre.

International Experts Raised Alarm in 2024

Problems within the heart and lung transplant service were first formally outlined in a 2024 report commissioned by the then-Conservative government and compiled by an international panel of experts. NHS England was tasked with implementing the report's recommendations, but surgeons and campaign groups believe progress has been unacceptably slow. Dr Zubir Ahmed, a Glasgow MP and kidney transplant surgeon who served as health minister responsible for transplantation before resigning from Sir Keir Starmer's government in May, said some elements of the transplant system were world-leading, particularly that services are free at the point of care. However, he called for NHS Blood and Transplant to be granted the power to commission services across the UK as part of ministers' planned closure of NHS England. "I don't think there is ever a need to cancel a transplant because of capacity issues," he said. In a statement, NHS England acknowledged that transplant services are complex and said it is "working hard to improve these life-saving services".