Independent report

SaBTO: Advisory Committee on the Safety of Blood, Tissues and Organs annual report 2019 to 2020

Published 5 August 2022

The report covers the:

• 37th meeting of SaBTO on 19 March 2019
• 38th meeting of SaBTO on 27 September 2019
• 39th meeting of SaBTO on 31 January 2020
• activities of working parties

Topics considered in 2019 to 2020

Donor Organ Risk Assessment (DORA) working group

Updates were provided on the work being done to look at the risk of transmission of cancer to organ recipients. DORA linked the UK transplant and national cancer registries to assess transmission risk from donors with cancer.

SaBTO members approved the final draft of the aide memoire, aiming to collate available existing guidance to provide a simply and easily accessible reference for transplant clinicians to facilitate appropriate matching of a donated organ to a specific recipient or type of recipient. The guidance will be provided via a web-based app and DORA will be responsible for updating the aide memoire.

A working group within DORA was established to look at the feasibility and cost of establishing a single national repository for donor and recipient serum samples.

Occult blood infection (OBI) working group

The OBI working group was established with Will Irving as chair. Members agreed that the group would look at the risk of transmission from donors with occult hepatitis B (HBV) and assess whether a change to the current testing strategy is required to identify occult donors. All 4 UK blood services are represented with the intention that any recommendations have the support of all the services.

Paediatric components working group (PCWG) update

The PCWG was established in October 2017 to review the current safety measures in place for transfusion recipients born on or after 1 January 1996. These safety measures were introduced to reduce the risk of transmission of variant Creutzfeldt-Jakob disease (vCJD) via blood components donated by people who may have been infected from consumption of meat or meat products from cows with bovine spongiform encephalopathy.

SaBTO undertook a stakeholder engagement exercise between February and March 2019. The aim was to seek the views of stakeholders who may be affected by any proposed change to the safety measures and were not represented on the working group.

Members agreed to the recommendation that the current risk reduction measures of the provision of imported plasma and apheresis platelets for individuals born on or after 1 January 1996 or with thrombotic thrombocytopenic purpura (TTP) be withdrawn. Other risk reduction measures for vCJD should remain in place.

The PCWG report was agreed to and finalised in September 2019.

Virology review subcommittee update

Agreement that the virology review subcommittee would review the SaBTO guidance on the use of organs, cells, tissues, blood and blood components from donors with identifiable risk of infection including human herpes virus types 8 (HHV-8), West Nile virus (WNV) and seasonal Influenza.

On seasonal influenza the committee agreed revised guidance on the suitability of organs for transplant from donors with seasonal influenza. The paper did not cover pandemic flu which would require specific advice when an outbreak occurred. The revised guidance considers current evidence and allows donors with seasonal influenza to be individually risk assessed for suitability to donate, given the broad spectrum of presentation. Organ specific contraindications remained unchanged, such as lower respiratory tract infection and myocarditis.

The HHV8 workstream had been established following a number of incidental findings of HHV8 associated disease in solid organ transplant recipients. The subcommittee agreed to investigate the rate of incidence and report back to the committee on progress.

Risk tolerability working group

SaBTO agreed to establish the working group in January 2020 to consider communication and public perception of risk, residual risk estimates for HBV, HCV and HIV and how these were calculated and published, and the safety framework used by SaBTO and UK blood services.

SaBTO has previously used several risk models including the ABO risk decision making framework. A draft of the terms of reference was circulated and discussed, MT commented on what a quantifiable risk would be and noted that levels of acceptable risk will vary between the public, recipients and their families, health care professionals and HM Treasury. The importance of stakeholder engagement was noted and the importance of having a consistent approach to how risk is presented.

Hepatitis E screening

The committee reviewed the introduced of hepatitis E screening during the period March 2016 to December 2018. Universal screening for HEV was introduced after publication of SaBTO guidelines. Donors are tested in pools of 24. In 2018, 422 donations had tested positive for HEV and were removed from the blood supply. Donors could return once they had cleared the virus. The number of donations testing HEV positive remained above the threshold for cost-effectiveness, and it was recommended that the screening strategy remained in place, subject to a further review in 2 years.

Membership 2019 to 2020

• James Neuberger (Chair)
• Stephen Thomas
• Susan Brailsford
• Akila Chandrasekar
• Andrea Harris
• James Powell
• Richard Knight
• Lynn Manson
• Alison Murdoch
• Peter Simmonds
• James Mason
• Gail Miflin
• Chris Callaghan
• Effrossyni Gkrania-Klotsas
• Mike Murphy
• Paul de Sousa
• Rachel Hilton
• Will Irving
• Jean Manson
• Charlotte Silver
• Roger Graham

SaBTO advertised for 2 new lay members and a prion disease specialist, all of whom were appointed by March 2019.