Calls to tweak NHS liver transplant algorithm following longer waits for younger patients

A computer algorithm designed by NHS Blood and Transplant to make liver transplant allocation fairer, is causing younger patients to wait longer for surgery, highlighting the complexities of designing a system that is viewed as fair for everyone.

According to a BBC Health report, NHS figures show younger people are currently waiting 156 days longer on average for a transplant than patients over 60.

Due to a shortage of liver donors, a computer algorithm – introduced by NHS BT in 2018 as part of the division’s ongoing digital transformation process – now decides who to prioritise on the waiting list.

The BBC reports that the algorithm tends to favour patients who are most likely to die sooner, which in practice, tends to be older people.

Before the algorithm came in 26- to 39-year-olds would expect to be on the list for an average of 172 days, which was about 40 days longer than patients over 60. Today, that gap has widened to over 200 days.

The organ allocation scheme runs on a cloud platform that supports automation.

In a 2018 interview with Computer Weekly NHS BT chief digital officer Aaron Powell said that by using tech that utilised automation, intelligence and integration, the organisation could improve its complex organ allocation scheme.

However, liver transplant surgeon Prof Nigel Heaton is now calling for the system to be tweaked so that younger people have the same opportunity as other age groups.

Heaton told the BBC that he struggles to support his younger patients when he believes they could be waiting for years. They tend to be born with liver disease or to have developed it early in life.

“It’s not something they’ve done through drinking, drugs, or lifestyle. This is something that they haven’t asked for.

“I think it’s our duty to try and do the best we can for them, and to restore them to a normal life.”

“They’re not going to die immediately, but you can see they’re deteriorating on the waiting lists. This jeopardises their chances of a successful transplant and some will die without getting successful transplantation.”

Three people on average still die in the UK every day waiting for a transplant and last year 69 people died before they could get a liver. There were 759 patients on the UK liver transplant list on 31 March 2022.

Besides re-examining the digital systems that choose who gets a transplant, NHS staff agree that persuading more people signing up as donors on the Organ Donor Register would also make a huge difference.