Xenotransplantation - Nuffield Council on Bioethics
Xenotransplantation - Nuffield Council on Bioethics
Xenotransplantation - Nuffield Council on Bioethics
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Effects <strong>on</strong> the health care system<br />
8.14 The development of xenotransplantati<strong>on</strong> into a successful clinical procedure,<br />
however, is some way in the future. This will allow the NHS to c<strong>on</strong>trol its<br />
introducti<strong>on</strong> and to assess it carefully. Research teams currently developing<br />
xenotransplantati<strong>on</strong> should keep accurate and accountable records of the costs of the<br />
procedures. In this way, policy makers will be in a better positi<strong>on</strong> to assess the cost<br />
implicati<strong>on</strong>s. Should xenotransplantati<strong>on</strong> cease to be experimental and become<br />
feasible as a clinical treatment, it should be restricted to designated centres for the<br />
foreseeable future. This would ensure adequate c<strong>on</strong>trol of costs and m<strong>on</strong>itoring of<br />
cost-effectiveness.<br />
8.15 One model for the provisi<strong>on</strong> of specialist services in the NHS is the Supra Regi<strong>on</strong>al<br />
Services Advisory Group. This Advisory Group is resp<strong>on</strong>sible for 10 designated<br />
specialist services including the Heart, Heart-Lung and Lung Transplant Service and<br />
the Liver Transplant Service. The Advisory Group was established as a result of the<br />
1991 NHS reforms with the following terms of reference:<br />
“To advise the Secretary of State, through Regi<strong>on</strong>al Chairmen of Health<br />
Authorities, <strong>on</strong> the identificati<strong>on</strong> of services to be funded supra regi<strong>on</strong>ally<br />
and <strong>on</strong> the appropriate level of provisi<strong>on</strong>.” 9<br />
Any such service is expected to meet the following criteria. It must:<br />
<br />
<br />
<br />
<br />
<br />
<br />
“already be an established clinical (not diagnostic) service and<br />
offer the treatment of choice;<br />
cover a c<strong>on</strong>diti<strong>on</strong> which is sufficiently rare that the service<br />
should <strong>on</strong>ly be provided by any single unit for a populati<strong>on</strong><br />
significantly larger than 5 milli<strong>on</strong>;<br />
relate to a clearly defined group of patients with a c<strong>on</strong>diti<strong>on</strong><br />
whose rarity is such that the nati<strong>on</strong>al caseload would not exceed<br />
1,000 and would normally be about 400 a year;<br />
be capable of being provided in a small number of centres which<br />
between them can meet the nati<strong>on</strong>al caseload and that the<br />
professi<strong>on</strong> would accept that the service should <strong>on</strong>ly be provided<br />
in a restricted number of centres;<br />
be able to justify its costs when set against alternative uses for<br />
NHS funds; and<br />
cost such an amount that it would c<strong>on</strong>stitute a significant<br />
burden for providers and purchasers.” 10<br />
9<br />
Supra Regi<strong>on</strong>al Services Advisory Group annual report (1994-5) p 6.<br />
10<br />
Supra Regi<strong>on</strong>al Services Advisory Group annual report (1994-5) p 7.<br />
99