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Dáil Éireann debate -
Wednesday, 7 May 1997

Vol. 478 No. 7

Priority Questions. - Heart and Lung Transplants.

Brian Cowen

Question:

11 Mr. Cowen asked the Minister for Health the plans, if any, he has for the development of a heart and lung transplant facility in the State in view of the fact that 13 young Irish people died in 1996 while waiting to be called for such transplants in Britain. [12309/97]

(Limerick East): The establishment of a successful transplant programme for any specialty is an extremely complex and difficult task. It is essential to have appropriately trained staff, suitable infrastructure and a multi-disciplinary approach to ensure successful outcomes.The Department's experience with the successful liver transplant programmes bear this out. The question of establishing a heart-lung transplant programme is being considered in this context.

I am aware of the difficulties being experienced by patients requiring lung or heart-lung transplants.I am considering the issues involved with a view to alleviating the difficulties for these patients. In light of the experience gained in establishing the liver transplant programme, it is likely that a phased approach will be adopted, recognising the need to build expertise and create a programme that is viable, in terms of the outcome for patients.

The Minister said that the establishment of a heart-lung transplant programme is being considered and that it is likely that a phased approach will be adopted. Will he provide more detail and indicate a timescale and the methodologies to be applied? Will Irish surgeons build expertise in the United Kingdom before such a facility is established here and teams are put together? The Minister said that he is aware — I am sure he has been made so aware by the Cystic Fibrosis Association of Ireland — of the difficulties being experienced by patients requiring lung or heart-lung transplants. Last year 47 patients were awaiting heart and lung transplants in the United Kingdom. Six were operated on successfully and of the remaining 41, 13 have since died. There is, therefore, a clear need for the Department and the Minister to accelerate their consideration of the matter.

(Limerick East): As Deputies are aware, there is no facility for lung or heart-lung transplantation in Ireland. It has been estimated that the annual lung and heart-lung transplant caseload would be 20 transplants approximately, if a programme could be commenced. Patients in need of these operations are referred by their consultants for assessment to any of three centres in the United Kingdom — Newcastle, Harefield and Cambridge — with a view to being put on a waiting list for a transplant. Figures to the end of 1996 indicate that in the region of 30-35 Irish patients are awaiting transplants in the United Kingdom. There is no formal agreement with the United Kingdom hospitals. Public patients are approved for travel by their local health board. I am aware of the difficulties being experienced by patients in having to travel to the United Kingdom but the caseload is small and it is difficult to build expertise.

The Department requested the Mater Hospital to prepare proposals concerning the feasibility of establishing a heart-lung transplant programme. We are listening to advice but there are a number of problems, including the cost involved, the small number of patients who require transplants and the consequent problem of building expertise in this area. Unless there is sufficient throughput, the consultants involved do not have sufficient cases to build expertise to the desired level. Other issues also arise.

Taking into account the experience gained in establishing the liver transplant programme, we should be able to make some progress along the lines suggested by the Deputy. Many patients travel to Harefield. I envisage Irish consultants travelling to a United Kingdom hospital on a term basis to build expertise and applying the skills learned here. No decision has been made as to the location. This is being explored by consultants at the Mater Hospital.

When was the Mater Hospital asked to prepare proposals concerning the feasibility of establishing a heart and lung transplant programme here? If there would be insufficient throughput, one could argue against establishing such a facility. If arrangements cannot be made with the three United Kingdom hospitals mentioned, transplants cannot be carried out. In the meantime patients will die as a result. To resolve the problem there is a need for a modus operandi. When does the Minister expect the Mater Hospital to present its submission and what formal arrangements can be made with the United Kingdom hospitals to ensure availability given the emergency nature of the operation involved?

(Limerick East): The contacts with the United Kingdom hospitals are well developed. Contact was made with the Mater Hospital in late 1995 and it made its proposal in December of that year but it was overtaken by other events. We have asked four hospitals to tender for a major cardiac unit to cater for 500 cases. Galway, Cork, the Mater Hospital and St. James's Hospital have submitted proposals. A recommendation has not yet been made, but a decision should be made shortly. That is one of the factors which impinges on the other issue. Those who work in a cardiac unit who have expertise, for example, in the area of heart transplants — approximately 130 have been carried out at the Mater Hospital — would have the expertise necessary in the area of heart-lung transplants.

Will the Minister agree this unit would be cost effective as the personnel, vascular surgeons etc. are already available? Such a unit would be multi-functional and could be used for other operations, including cardiovascular operations.Every effort should be made to set up such a unit as the personnel are available and it would be cost effective.

(Limerick East): The approach I take will ensure there is an arrangement with the centres of expertise in the UK, particularly at Harefield, so that Irish cases are dealt with on referral from Irish hospitals. However, there is also a wider issue involved. As Deputies are aware, despite the progress made by the Government, there are still significant waiting lists for elective surgery. Some of the waiting lists which must be attacked by way of investment are in the cardiac area, for example, the waiting lists for double by-pass, triple by-pass and heart transplant operations. This is the priority I referred to when I said four tenders are with the Department for units which would be able to cope with 500 operations a years. A decision on these will be made shortly and, in that context, it may be possible to put in place here the facility now available to Irish citizens in the UK.

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