Professor Derek Manas, medical director of NHS Blood and Transplant, has raised significant concerns about the state of organ transplant services in England in a letter to NHS England leadership and patient advocates. He characterized the current system as fragmented, with inadequate accountability structures and operational inefficiencies that have undermined the effectiveness of life-saving procedures.
Manas identified multiple systemic problems within transplant services. The structure creates misalignment between individual hospitals’ waiting lists, available organs, surgical capacity, and operating theatre availability, resulting in last-minute cancellations and inconsistent use of donated organs. He noted that NHS England has not actively managed waiting lists or worked to ensure fairness in distribution. Additionally, half of the six UK heart and lung transplantation centres have experienced departures of senior surgeons within the preceding two years, with specialists seeking opportunities internationally. Manas attributed these staffing issues to inadequate workforce planning that has contributed to burnout among transplant surgeons and their teams, alongside recruitment and retention challenges.
The broader context reveals longstanding challenges in heart and lung transplantation capacity. The number of such transplants performed annually has remained flat for 30 years. The NHS transplants approximately one in 10 donated lungs and one in seven donated hearts, substantially lower proportions than those achieved in comparable Western nations. Waiting times for heart transplants vary considerably depending on location, ranging from eight months to four-and-a-half years. The service also contends with insufficient investment in modern technology, limited theatre space, and inadequate intensive care bed availability.
Proposals for reform have emerged from multiple quarters. Dr. Zubir Ahmed, a former health minister and kidney transplant surgeon, has suggested expanding NHS Blood and Transplant’s authority to commission services across the UK as part of planned restructuring, which could facilitate more efficient patient transfers and organ allocation. An international expert report commissioned in 2024 outlined problems in heart and lung transplant services, with recommendations that NHS England was tasked to implement. NHS England responded to these criticisms by stating it is pursuing various improvement initiatives aimed at increasing transplant volumes, reducing service variation, and improving patient identification and access.
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