Doctor defends 'high-risk' heart transplants

Published on Saturday 6 September 2008 19:36

THE head of Scotland's heart transplant service last night vowed to carry on with "high-risk" operations despite his unit having been closed down earlier this year because of a number of deaths.

Professor Henry Dargie, director of the national heart transplant unit, based in Glasgow, admitted to Scotland on Sunday that two patients who died after transplants were so ill they were "right at the limits" of standing a chance of success.

The deaths of the four patients led to the unit being closed from December 2007 to January this year while experts investigated.

Scotland on Sunday has now obtained the report, which concludes:

• None of the transplants were classed as "inappropriate" but some were of a "relatively high risk";

• Two patients were "very advanced" in their heart failure, which reduced their chances of a successful operation but surgeons went ahead;

• One patient received a heart described as a "mismatch" because the donor was smaller than the recipient;

• Glasgow's location in the UK means a long travelling time for donor hearts, increasing the risk of failed heart transplants.

The investigation began after four out of 11 patients who received new organs last year at the unit died within 30 days. The figure was nearly three times the "normal" death rate of 13%. Scottish patients waiting for transplants were temporarily referred to the waiting list in Newcastle while the review was carried out.

Dargie said: "The reason why the alarms were triggered is because the mortality rate had exceeded the boundary set for all transplant units. Two of the patients were at the high end of our risk scale. We believed that if we had not done the transplants, the patients would almost certainly have died.

"In these two cases no one was in doubt that we should do it. In different circumstances in a different patient we might have made a different decision. But each of these patients were aware of the risks and they went for it. There does come a point where patients are too sick to have a transplant. We were right at the limits with these people. So the fact that they died is disappointing but not entirely surprising."

He added that he believed a third patient who died after being given a heart from a smaller female – described in the report as a "size and gender mismatch" – might have survived if he had received a different heart.

Dargie said: "That is possible but this is a once-in-a-lifetime situation and our selection criteria have served our patients well in the great majority of cases."

The investigation was carried out by Professor Robert Bonser, a consultant cardiothoracic surgeon at the University Hospital Birmingham NHS Foundation Trust.

The report contains 12 recommendations the unit must implement, including better monitoring of its patients out of hospital. It also calls for a review of the unit's matching criteria to increase patients' chances of survival. Operations have now resumed at the unit, at a new location at the Golden Jubilee Hospital, Clydebank, and so far no patients have died.

David Nix, chairman of the Donor Family Network said: "I believe the medical staff are doing their best in what is a total minefield and we are 100% behind them. Every situation is different."

Case study

The death of Ann Scroggie's husband, Jamie, in May 2007, three weeks after a heart transplant, was one of the four in Glasgow that prompted the temporary closure.

She welcomed the report and said that despite his death she was happy that surgeons had done everything they could.

Jamie, a civil servant, led an active life, enjoying hillwalking and being outdoors until he fell ill with cardiomyopathy in 1996.

The grandfather-of-two's health deteriorated and a heart transplant was his only hope because he found everyday tasks impossible.

The condition, a disease of the heart muscle, led to heart failure and he was placed on the transplant list. But despite a match being found within several months, he died of complications shortly after the procedure, at the age of 56.

Ann who lives in Larkhall, Lanarkshire, said: "Jamie was absolutely delighted when they found a heart for him. It had been a race against time. We were fully aware of the risks of having the heart transplant; we knew it might not be a success, but you only think of the positives and hope for the best. Jamie had been very ill."

She added: "I think it must have been terrible for the doctors making these decisions. They were damned if they did and damned if they didn't. I can understand how some people might say the operations should not have been done, but I think the surgeons are between a rock and a hard place. The operation is the one chance and if it's a success that's brilliant and if it's not, then it's not. But I was quite happy with how Jamie's case was handled. I am happy with the report. I think the staff did all they could."