Professor J Andrew Bradley, Head of the Department of Surgery at the School of Clinical Medicine, University of Cambridge, takes us on a journey from the beginnings of transplant surgery to the cutting-edge procedures in use today.
Professor Bradley will be speaking at this year’s Festival during the event Organ transplantation.
CSF: Why did you become a surgeon? And what attributes would someone need to become a surgeon?
JAB: As a medical student in Leeds, I was very fortunate to have the opportunity to study in a world famous University Department of Surgery. It was by far the most exciting and inspirational undergraduate teaching I received and I knew immediately that this was the career path I wanted to follow. I haven't looked back since. Many of the attributes required to become a surgeon are the same as those for any practicing doctor, namely compassion, integrity, a broad medical knowledge, good communication skills and the ability to work effectively in a team. In addition, however, a surgeon must be technically able and have the ability to make good decisions under pressure.
CSF: What specifically drew you to transplantation surgery research?
JAB: I first encountered organ transplant surgery during my surgical training in Glasgow. I was immediately drawn to transplantation as a specialty because it had an immediate life-transforming impact on patients’ lives, and the procedure to implant a new organ contrasted with many other types of surgery where the surgical procedure consists of removing diseased tissue.
Transplantation surgery also requires a good knowledge of immunology, the ability to recognise and deal with medical problems, and the need to consider various ethical issues, all of which I enjoy. While the technical aspects of organ transplantation are for the most part already optimised, there is much research still to be done to improve transplantation. The major challenges are the severe shortage of suitable donor organs, graft rejection, and the need to minimise the long-term detrimental effects of the immunosuppressive treatment used to prevent graft rejection.
CSF: In terms of surgery, it’s a highly complex procedure. What are the main risks during and following transplantation?
JAB: Organ transplantation is relatively complex surgery and the patients who require it are by definition very unwell and therefore at potential risk of various complications. However, it is important to remember that transplantation is only performed in a limited number of designated major centres with highly trained multi-disciplinary teams, and a great deal of expertise at recognising and dealing effectively with problems that may arise during and after surgery. These may range from bleeding, infection and graft rejection, but in most cases these can be dealt with effectively and overall the results of organ transplantation are very good.
CSF: Are these risks being diminished with better drugs and advances in surgical technique?
JAB: The results of organ transplantation have improved progressively over the years. There are many reasons for this, and they include improvements in the selection and preparation of patients for organ transplantation, improvements in anaesthesiology, surgery and intensive care, improved tests to diagnose infection and better drugs for preventing and treating infection, and new drugs for preventing graft rejection. It is difficult to say which of these developments have had most impact but collectively they have led to a gradual improvement in patient outcomes.
CSF: What role does technology play in organ transplantation?
JAB: Technology plays a vital role in organ transplantation. For example, about one-third of all kidney transplants in the UK are performed using kidneys from living donors. Historically, the donor underwent removal of their kidney through a large and potentially painful incision in their side. Now, however, the donor kidney is removed using laparoscopic (key hole) surgery where a much smaller and less painful incision is required, enabling the donor to leave hospital sooner and return to work earlier. Another example of the impact of technology is the increasing use of organ perfusion machines to aid the assessment and preservation of donor organs until they can be transplanted. This technology is at a relatively early stage of development but has the potential to transform organ transplantation practice by reducing the need to discard organs because of uncertainty about their quality, and allowing the repair and resuscitation of sub-optimal or injured donor organs.
CSF: Which organs cannot be transplanted and why?
JAB: Transplantation of the kidneys, liver, pancreas, small intestine, heart and lungs are all now routine for carefully selected patients. Limb and face transplants are being carried out in a small number of centres worldwide, but technically such transplants are ‘composite tissue’ transplants rather than organ transplants. The possibility of uterine transplantation is being evaluated but is not routine. From a technical perspective most organs can be transplanted (except the brain and sensory organs).
CSF: With the advances being made in stem cell research and technology, do you think organ transplantation from a doner will be a thing of the past in the not too distant future?
JAB: The advances in stem cell medicine are remarkable and will undoubtedly lead to major new treatments. However, organs are highly complex and comprise a number of different cell types arranged in a unique architectural structure and I don’t think it will be possible to build such organs in the laboratory for decades.