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Keeping livers ‘alive’ boosts transplant success, trial finds

Keeping donated livers “alive” with a machine prior to transplants boosts the chances of a successfu..

Keeping donated livers "alive" with a machine prior to transplants boosts the chances of a successful operation, a landmark trial has found.

Usually livers are kept in ice prior before the surgery, but many become damaged and unusable as a result.

For this study, scientists put them in a perfusion machine, pumping the organs with blood, nutrients and medicines.

More of these "warm" livers went on to be transplanted and showed less damage than the "cold" ones, the trial found.

Scientists said the study could help to reduce the significant proportion of people who die waiting for a new liver and potentially "transform" how organ transplants are carried out.

'Major impact'

The randomised controlled trial involved 222 liver transplants in seven European centres.

It compared liver transplants where the organs were first preserved in an ice box with those kept "alive" outside the body using a so-called normothermic perfusion machine.

Out of the 220 transplants scientists analysed, the study found there was 50% less tissue damage in the "warm" livers – a key marker of how likely the organ is to survive as well as the transplant patient themselves.

Scientists were also able to successfully transplant more of the warm livers than cold ones.

Just 16 out of 137 warm livers needed to be discarded compared with 32 out of 133 cold ones, meaning 222 transplants were able to go ahead. All but two were analysed by the team.

Prof Peter Friend, one of the authors of the study in the journal Nature and one of the inventors of the machine, said currently about a third of donated livers could not be used for transplantation due to a range of factors.

These include livers taken from elderly people or those in poor health, which were more likely to fail, damage occurring while the organ was removed from the donor's body and damage sustained while being kept in ice.

About 20% of patients die while waiting for a liver transplant, he said.

Keeping the liver "alive" outside the body helps it recover from the damage it suffers during the process of being removed from the donor's body, authors said.

"There's a huge issue in terms of the [high] number of patients compared to donor organs, and yet we're not using all of the donor organs that are available," Prof Friend told the BBC.

"If we can go some way towards utilising the livers that are not transplanted it would have a major impact."


BBC medical correspondent Fergus Walsh

There are machines that can keep the heart beating and nourished outside the body.

I have witnessed one of these heart-in-a-box machines in operation – and could see – and even touch – a pig's heart beating under the plastic covers.

There are also machines that can keep kidneys preserved at body temperature.

There has been such significant progress in this field that this trial may signal the beginning of the end of keeping donor organs on ice – although it could be several years before every transplant centre has this technology.

'I feel a lot fitter'

David Radford, 63, from Oxford, needed a transplant after having liver cancer.

He took part in the trial and was one of those who received a "warmed" liver.

Mr Radford said his surgeon told him that when he performed the transplant "he had never seen anything quite like it before".

"Normally when he inserted an organ into the recipient it took about 30 seconds or so before it started working and there was a major dip in the blood pressure," Mr Radford said.

"But with me he was quite surprised that there was no change in the blood pressure at all and everything seemed to start working immediately."

Mr Radford has since been skiing and now regularly does classes of tai-chi, yoga and kung-fu.

"It hasn't impaired me at all. If anything I feel a lot fitter than before."

'Landmark study'

Much smaller studies have looked at the use of the technology before but this is the first large randomised controlled trial to compare it with ice-box storage to see which is most effective.

Prof Friend said he thought the technology could potentially transform how organ transplants are carried out.

"The concept of keeping organs alive and functioning appears to be completely transferrable between different other organ types," he said.

Liver perfusion is currently performed on the NHS in a small number of specialist centres in the UK.

But experts say the technology is expensive and a cost analysis will need to be carried out before it is offered more widely.

Stephen Wigmore, professor of transplant surgery at the University of Edinburgh, who was not involved in the trial, said it was a "landmark" study.

"Whereas before the conclusions that could be drawn [about organ perfusion] were slightly weak and anecdotal, this is scientifically robust in its design and statistical power, so we're more certain about the outcomes being good in this study."

Barry Fuller, professor of surgery at University College London, said the research presented a "very significant advance" in the use of the technology.

"The challenge now is to make the technology widely used and logistically manageable and affordable."

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Burkina Faso: Growing Violence Threatens Health Care

Away from the worlds attention, Burkina Faso has been slipping into violence. In less than a year, t..

Away from the worlds attention, Burkina Faso has been slipping into violence. In less than a year, the number of displaced has increased fivefold, from 50,000 last December, to 270,000 in August. As ever, the most vulnerable suffer most: the very young, and the very old.

When Alidou Sawadogos elderly mother fell ill, he faced a long and dangerous journey to get treatment for her.

“When she collapsed, a friend called me,” he explains. “By the time I arrived she was already unconscious. I decided to take her to the health center and luckily someone who had a motorcycle helped me. Because of the violence many people who are sick wait at home and die. Everyone is afraid of taking the road to the health center in Barsalogho.”

Across Burkina Faso, the rising insecurity has forced over a hundred health centers to close, or to limit their work. Half a million people now have little or no access to health care. Dedicated health workers, among them Dr Bertrand Dibli in Barsalogho, are struggling to meet the needs, and to stay safe themselves.

“This is one of the few health centers that isnt closed,” he says. “We dont have enough equipment. And the insecurity has caused huge anxiety among health workers. Even coming here to Barsalogho is a huge challenge because the route is so dangerous.”

The ICRC has been working to support Burkina Fasos health professionals, with medical kits, and vaccination campaigns. During his visit to the country, ICRC President Peter Maurer expressed his concern at the multiple challenges facing Burkina Fasos people.

“We are very concerned,” he said. “Very worried about the upsurge in violence, its a vicious circle that is trapping the civilian population between armed groups.”

“We also see,” Mr Maurer added, “that it is not only the violence that is affecting the country, it is also under development, and climate change. Together with the violence that is obstructing the health services, its an accumulation of factors.”

And so the ICRC – jointly with the Burkinabé Red Cross – is also delivering food to the displaced, and helping to improve access to water supplies. All of this, says nurse Jeanette Kientega, is desperately needed by a population uprooted by conflict, and denied access to basic health care.

“By the time they are able to get here, it is often too late” she says. “Sometimes we can help, but if they have already been ill a long time, it is difficult. We try to do what we can.” (more…)

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World Bank and WHO Statement on Partnership & Deployment of Financing to WHO for Ebola Response in DRC

WASHINGTON, August 23, 2019—The World Bank and the World Health Organization (WHO), along with the G..

WASHINGTON, August 23, 2019—The World Bank and the World Health Organization (WHO), along with the Government and other key partners, are working in close partnership on the Ebola Crisis Response in the Democratic Republic of the Congo (DRC). Central to this partnership is the assessment of the financing needs, and deployment of resources, with the goal to put an end to the current deadly outbreak.

The World Bank is today announcing that US$50 million in funding is to be released to WHO for its lifesaving operational work on the frontlines of the outbreak. The WHO is announcing that this US$50 million in funds will close the financing gap for its emergency health response in DRC through to the end of September 2019, and is calling on other partners to mirror this generous support in order to fund the response through to December.

The funding comprises US$30 million from the Pandemic Emergency Financing Facility (PEF) and US$20 million from the World Bank. The US$50 million in grant funding is part of the larger financial package of approximately US$300 million that the World Bank announced last month to support the fourth Strategic Response Plan for the DRC Ebola outbreak.

“WHO is very grateful for the World Banks support, which fills a critical gap in our immediate needs for Ebola response efforts in DRC, and will enable the heroic workers on the frontlines of this fight to continue their lifesaving work,” said Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization. “We keenly await further funding from other partners to sustain the response through to the end of the year.”

The DRC government, working in collaboration with the World Bank, WHO, and other key partners, has finalized the Fourth Strategic Response Plan (SRP4), which outlines the total resources needed for the DRC Ebola Crisis Response from July to December 2019. The financing announced today is part of the World Banks previously announced financial package of up to US$300 million and covers over half of SRP4s needs, with the remainder requiring additional funding from other donors and partners.

“The World Bank is working closely with WHO, the Government of DRC, and all partners to do everything we can to put an end to the latest Ebola outbreak,” said Annette Dixon, Vice President, Human Development at the World Bank. “The partnership between our organizations and the Government is critical for responding to the emergency as well as rebuilding systems for delivery of basic services and to restoring the trust of communities.”

The Government of DRC requested US$30 million from the PEF Cash Window to be paid directly to WHO. The PEF Steering Body approved the request bringing the PEFs total contribution to fighting Ebola in DRC to US$61.4 million. The PEF is a financing mechanism housed at the World Bank; its Steering Body is co-chaired by the World Bank and WHO, and comprises donor country members from Japan, Germany and Australia. The quick and flexible financing it provides saves lives, by enabling governments and international responders to concentrate on fighting Ebola—not fundraising.

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Borno State launches first Malaria Operational Plan, reawakens fight against malaria

Maiduguri, 13 August 2019 – Following recommendations from malaria interventions in Borno State Nige..

Maiduguri, 13 August 2019 – Following recommendations from malaria interventions in Borno State Nigeria, the Malaria Annual Operational Plan (MAOP) was developed and launched on 08 August 2019 with technical support from the World Health Organization (WHO) and partners. Aligned to the National Malaria Strategic Plan (2014 -2020), MAOP was developed through a broad-based stakeholders workshop involving malaria stakeholders, reviewed on different thematic areas and endorsed by the Commissioner for Health and Permanent Secretary, Borno State Ministry of Health.

Speaking during the launch, the Borno state Malaria Programme Manager, Mr Mala Waziri described the MAOP as the first to be endorsed and disseminated in Borno State. “WHO has made us proud by supporting the first ever Malaria Operational Plan right from development, review, printing to dissemination.”

Dr Ibrahim Kida, the Ministerial Secretary Borno State Ministry of Health and Incident Manager of the state, described the launch as “an historic event as stakeholders across the health sector made commitments to use the document as an implementation guide for all malaria programs”. The plan was also described as an advocacy tool for planning domestic funds mobilization.

The MAOP has seven objectives among which are: provide at least 50% of targeted population with appropriate preventive measures by 2020; ensure that all persons with suspected malaria who seek care are tested with Rapid Diagnostic Test (RDT) or microscopy by 2020 and all persons with confirmed malaria seen in private or public health facilities receive prompt treatment with an effective anti-malarial drug by 2020.

The MAOP will further ensure that at least 50% of the population practice appropriate malaria prevention and management by 2020, ensuring timely availability of appropriate anti-malarial medicines and commodities required for prevention, diagnosis and treatment of malaria in Borno State by 2020.

In addition, it seeks to ensure that all health facilities report on key malaria indicators routinely by 2020 and finally strengthen governance and coordination of all stakeholders for effective program implementation towards an A rating by 2020 on a standardized scorecard. These strategic objectives have specific targets and the MAOP takes into account the humanitarian response.

“Malaria remains a leading cause of poor health in Nigeria. According to the 2018 WHO Malaria Report, 53million cases are recorded annually in Nigeria, roughly 1 in 4 persons is infected with malaria contributing 25% of the global burden,” says Dr Nglass Ini Abasi, WHO Malaria Consultant for the North East.

“Furthermore, 81,640 deaths are recorded annually (9 deaths every hour), which accounts for 19% of global malaria deaths (1 in 5 global malaria deaths) and 45% malaria deaths in West Africa. The Nigeria Malaria Strategic Plan (NMSP) 2014-2020 has a goal to reduce malaria burden to pre-elimination levels and bring malaria-related mortality to zero and WHO is working assiduously with Government to ensure the burden is reduced accordingly.”

Results from WHO’s Early Warning, Alert and Response System (EWARS) week 30 report from 223 sites, (including 32 IDP camps) show that malaria was the leading cause of morbidity and mortality accounting for 35% of cases and 46% of reported deaths. In addition, results from the Nigeria Humanitarian Response Strategy (NHRS 2019-2021) indicate 7.1million people are in dire need of healthcare and 6.2million are targeted for immediate attention.

Despite recent improvements, insecurity remains a challenge limiting access to the functional health facilities. Easily preventable and treatable diseases such as malaria, acute respiratory infection and diarrheal diseases account for the greatest proportion of morbidity and mortality among the vulnerable population. Furthermore, Malaria is endemic in North East Nigeria and the transmission is perennial with a marked seasonal peak from July to November every year. (more…)

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