Addenbrooke's Charitable Trust

Spotlight on Professor Chris Watson

Transplanting livers is all in a day's work for Professor Chris Watson. We find out his hopes and dreams for transplant and uncover his hidden photography talents...

Wednesday, April 18, 2018

Tell us about yourself
I trained here as a medical student then I went as a junior doctor to Durham for a while. Then I came back and worked in Luton and Newmarket and did a registrar rotation starting in Papworth before coming back to Addenbrookes. As a senior registrar I trained here in  transplantation and at Oxford in vascular surgery. Following this, I started in Oxford as a consultant doing vascular and transplant surgery and finally came back here in 1998 as a transplant surgeon and university lecturer.

What does a ‘normal’ day entail? 
My days are quite variable. Today I had nothing on my agenda but now I’m going to find myself in theatre at some stage this afternoon so it can vary. It’s a bit the nature of transplantation – it’s unpredictable. But if I’m on call then it would be a question of taking offers of organs and doing the transplants and if I’m not on call, then it might be clinics or doing some research.

What prompted you to work in livers?
When I was a houseman I worked with Neville Jamieson who was then my Senior Registrar and is now a Senior Consultant and about to retire. I got involved in an organ retrieval when I was working with him and then as an SHO when I was out in Newmarket, I came over here and assisted with liver transplants, which usually happened in the middle of the night then, and they do now! That’s where my interest really kindled.

You can turn someone’s life completely around. None of us know what’s around the corner. Some patients might develop a cancer that might kill them or have a heart attack that might kill them and some patients develop organ failure. With a transplant you can replace a diseased organ and restore patients to a near normal quality of life and the prospect of a much longer life than they would have otherwise.

What have been the recent developments in liver transplantation? How have these transformed this area for patients and clinicians?
The main issue for all transplants is the shortage of organs. We lose around 10-15% patients who are on the waiting list waiting for a liver transplant. The figures aren't as good for lung transplants and heart transplants and we have a restriction for who we put on the list. You have to have a reasonable anticipation that patients will do well.

The breakthrough has been our increased use of less than ideal organs and getting them to work well. Particularly organs from donors who’ve died a circulatory death where their heart is stopped, the blood supply to the liver is stopped. They are transferred to the operating theatre and we typically used to cool the liver down by flushing it with cold preservation solution and then remove it. Now, we have a number of different things we can do to try to improve the quality of the organ before we transplant it.

Circulatory death donors made up 5% of our donors in the UK ten years ago and this has now increased to 42% in the last year. They provide 40% of the liver transplants we do in our hospital and that’s the highest proportion in the country. Typically, it’s about 25% of livers that are taken from the DCD donors but we’ve developed tricks to make them work better and are making more use of them.

What is liver perfusion and how will this help patients? What is your dream for this technology?
Liver perfusion is a way of testing a liver before you transplant it. We put the liver on the machine and it pumps oxygenated blood through it, so it gets the liver working as it does in your body. We can then measure some of the biochemical functions that are going on to check that the liver is working. We can look at the production of bile and what the bile’s made of and check that the bile ducts are working properly. If we’re satisfied with both those aspects, we can take it off the machine and put it in the patient. This method has allowed us to use livers that previously we would have turned down because we weren’t sure whether they would work or not. If you transplant a liver that doesn’t work into someone, then they have a two in three chance of receiving a replacement as an emergency. Patients who are listed as an emergency have priority over non emergency cases for the next liver anywhere in the country. However, there’s still a 1 in 3 chance they’d die waiting. We try not to put patients in that situation, which is how the technology is helping us.

Now we are able to assess the livers to see which ones are going to work or not, we’d like to be able to turn them around and treat those livers that we don’t think would work in a way that would make them work. 

How long does perfusion take?
At the moment it would take about four hours, we’ve sometimes gone up to eight. The machine we hope to buy with the money raised by ACT supporters would allow us to perfuse livers for 24 hours, giving us enough time to treat less good livers and make them safe to transplant.

How can ACT supporters help?
We need a machine to make this a routine treatment. The one we use at the moment is a very cumbersome thing. We’ve got a lot of questions we need to answer using our machine on animal livers, pig livers for example, and after doing this, we can’t go back and use the machine on humans. We’d need to show that the machine is cost effective and justify its ongoing use to the Trust.

What challenges do you face and how do you overcome them?
It’s similar challenges to those in the rest of the hospital. We’re short of beds. Access to the operating theatre for livers is good but not as good as kidneys and pancreases. And if there are other patients needing emergency operations that take priority, then our organs wait longer. The longer our organs wait on ice, the poorer the results are so our challenge is to try and get the organ into the recipient as quickly as possible once we know it’s suitable to transplant.

What’s the best thing about your job?
The best thing is seeing patients turned around afterwards. Seeing patients coming in looking bright yellow and very sick and then you see them afterwards. Often you don’t recognise them because they’re looking so much better. 

What do you not like about your job?
Most of the transplants take place at night time now. It would be lovely to start one at seven in the morning! Someone has to operate at night – it’s either the team going to retrieve the organs from the donor or the surgeons putting them in. So often I've worked a normal day and then do a transplant at night.

One of the best things is our team. We have a very good team of colleagues who will come and take over if you’ve been up all night even if they’re not on call. If there’s a problem, people come out of the woodwork to help which is very impressive.

How has ACT funding helped this department?
ACT has bought a near patient biochemistry machine (Piccolo) so that we can test blood going round the liver to see what the results are and get them back immediately rather than send them off to the laboratories. This has allowed us to make real time decisions and optimise the timing of transplants.

If you could change anything (about your job/in your field) what would it be?
It’s a difficult area to be in because you rely on someone dying so a patient can live. The ideal way would be to develop a way to stop organ failure. We’re patching things up and putting replacement bits in but it’d be much better if you could avoid that in the first place.

The donor families go through a lot when the donor dies and then we go and ask them ‘do you mind donating the organs as well?’. So, when they’re at the lowest point of their lives they get asked a question that’s got a profound effect on other people and it’s really impressive that people say ‘yes’.

What do you like to do in your spare time?
Wildlife photography. My wife and I go travelling and take photos. It’s a hobby – a way of doing something away from work. I realised after a couple of years as a consultant that I needed to get out and away, and so I took it up as an escape.

Well, we think Chris is rather good!

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