Ivor Callely
Ceist:89 Mr. Callely asked the Minister for Health the basis for his decision to put on hold the provision of a paediatric liver transplant programme at Our Lady's Hospital, Crumlin, Dublin 12. [23415/96]
Written Answers. - Paediatric Liver Transplant Programme.
Limerick East): The recent decision not to re-establish a paediatric liver transplantation in this country was taken following a detailed study by the Department, undertaken in consultation with management, medical and nursing representatives from Our Lady's Hospital, Crumlin, and St. Vincent's Hospital, Dublin. My Department also commissioned extensive international research into the issue and had discussions with leading specialists from the United Kingdom and elsewhere.
Paediatric liver transplants were previously carried out at Our Lady's Hospital under the National Liver Transplant Programme which commenced in 1985. By 1990 it had become apparent that the initial results achieved by the paediatric component of the programme were poor. Four out of five children had died. One of the principal reasons advanced was that Ireland did not generate sufficient cases to support a viable programme with appropriate expertise.
From March 1991 paediatric patients from Ireland requiring liver transplantation have been referred to King's College Hospital, London, under an agreement with Camberwell Health Authority. The Department has concluded, following a comprehensive review of the issue, that it would not be appropriate at this point to re-establish a paediatric liver transplant programme in this country. The Department is mindful of the excellent and comprehensive service which King's College Hospital continues to provide, achieving success rates which compare favourably with other transplant centres in Europe. Also, in line with the health strategy, Shaping a Healthier Future, the Department considers that the overriding priority in considering the development and organisation of a viable paediatric liver transplant programme in Ireland must be the quality of care and outcome for patients.
It is considered that one of the critical success factors in the delivery of a quality paediatric liver transplant programme is the level of transplant activity in such a programme. The Department has concluded, based on recommendations from the representatives of Our Lady's Hospital and St. Vincent's Hospital and from acknowledged experts in the field of paediatric liver transplantation, that the average number of suitable transplants under a transplant programme serving Irish based patients would not exceed two cases per annum. It has been established that this level of activity would be very low in the European context, thereby raising a concern over the ability of a transplant programme with such low numbers to maintain the required level of expertise.
It is acknowledged that the social costs of undergoing a liver transplant at King's College Hospital are considerable. Hospital accommodation and separation from other family members creates additional stress and expense for patients and their families. Accordingly, my Department has invited proposals from Our Lady's Hospital and St. Vincents Hospital as to practical improvements which might be put in place to address this problem.
I recognise that there is a strong commitment among the management, surgical, medical and nursing staff at Our Lady's Hospital to the provision of a quality paediatric liver service. It is also acknowledged that Our Lady's Hospital continues to provide a comprehensive tertiary referral service including per and long-term post operative care for all the paediatric liver transplant cases. The question of re-establishing a paediatric liver transplant programme will be kept under review by my Department.