All organ transplant options for children very costly

Virtually all of the options open to the Government to secure heart or liver transplants for the small number of children requiring such surgery each year will be very costly.

There is no national paediatric heart and liver transplant service in Ireland and up to now the Government has arranged for children with end-stage cardiac or liver failure to receive such life-saving surgery in hospitals in the UK.

However there is an international shortage of organs and when the call comes to patients, timing is critical. Patients must present at the transplant centre in the UK within four hours of notification of a donor heart becoming available and within six hours of a liver becoming available.

There is no dedicated air ambulance for making these "priority 1" transfers to the UK. Historically patients were brought to the UK by the Air Corps or the Irish Coast Guard .

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However due to shortage of capacity and regulatory changes, neither the Air Corps or Irish Coast Guard will from this month be in a position to provide such transfers of patients at nighttime.

The problem for the Government is that such transfers of children to the UK for transplants are rare – on average five per year – and having a dedicated aircraft and crew on standby every night would be very expensive. However, at the same time, three-quarters of such priority 1 transfers that do take place occur between 7pm and 7am .

24/7 capacity

The dilemma for Government is that providing 24/7 capacity for such transfers would come at a substantial cost and the service may be used only infrequently at a time when money is scarce elsewhere in the health system. However leaving such patients without the chance of securing a transplant would not be an acceptable option either.

A new report by health watchdog Hiqa says continuing to avail of UK transplant services will require either alternative options for night-time priority 1 transfers or the relocation of patients to the UK.

However, it maintains that not all patients may be suitable for relocation for either clinical or family reasons.

“Therefore, relocation does not negate the requirement for a priority 1 transfer service.”

Hiqa says that most reliable immediate transfer options are costly.

It says the optimal immediate option is to pay a private provider to deliver a dedicated night-time service.

The report says quotes given to the HSE for an aircraft with dedicated pilots on either 7pm-7am standby or permanent 24-hour standby and, based at Dublin airport, ranged from €900,000 to €3.7 million per annum.

“The service costs quoted do not include the charge per flight which would comprise airport landing and handling charges and hourly flight costs.”

Air ambulance

“Short-term nightly bookings of private air ambulance providers with the requirement to base in Dublin range in price from €15,000 to over €30,000 depending on the availability of aircraft and length of the notice period.”

The Hiqa report says short-term options include limited renegotiation of the contract providing for Coast Guard helicopter services to change shift rosters that would allow for patients to be flown to the UK at night. It says the feasibility and cost of this option are uncertain but suggests it would be expensive.

It says other options could involve a dedicated air ambulance being leased by a registered charity delivering airborne medical services including priority 1 transfers at a lower cost than the HSE could negotiate with a private provider or having the Coast Guard fly patients to the UK under rules in place for search and rescue operations. However, the report says while these options would be less costly it describes both as “speculative” and raises doubts about their feasibility.

The report says the preferred long-term option is likely to be based around either the Irish Coast Guard or the Air Corps.

“The Irish Coast Guard could incorporate provision of an additional aircraft and aircrew with a primary remit to provide air ambulance services to be included in the next contract, potentially in 2022.

“The Air Corps could be engaged either through the provision of an air ambulance service on an ‘as available’ basis or through a model similar to the one in operation for the Garda helicopter service. In such a scenario, the Air Corp would provide a crew to operate aircraft provided by the HSE.”

Aeromedical service

However, it says long-term design of an integrated aeromedical service for Ireland could provide resilience by leveraging access to multiple aircraft and aircrews from one or more providers and would have the advantage of providing a more coherent and efficient solution to the national aeromedical requirements.

The report also points out that developing a national transplant service to remove the need for transfers to the UK would also be costly and have its own drawbacks.

Hiqa says, for example, the development of a paediatric heart transplantation service in Ireland would require substantial additional resources and capital investment.

The report also warns that a highly important consideration in the development of an Irish paediatric transplantation service would be the potential loss of or reduction in access to the UK’s larger donor pool.