Mr Mohamed Elzawahry, Clinical Research Fellow, from the Oxford Transplant Centre at the University of Oxford, attended the BTS congress to present his work

The British Transplantation Society (BTS) annual congress was held in Harrogate, UK from 6th to 8th March 2024. Additionally, on Tuesday 5th March, before the official start of the congress, there was a post-graduate masterclass that featured a set of very interesting talks around sustainability and organ offering for transplantation. The congress was focused on sustainability and resource management in transplantation, this was emphasized by the choice of plenary discussions and talks showcased throughout the 3 days.

Our group submitted a number of abstracts on our work using QUOD samples, which investigate multiple transplant related questions, and we were delighted to be invited to present in multiple oral sessions. Dr Sarah Cross presented an update on QUOD and highlighted some of the research studies that the biobank has supported in the Basic Science session ‘Combatting Ageing’ which was co-moderated by Dr Maria Kaisar. Later in the congress, Dr Ioannis Michelakis presented “Donor Cystatin-C association with posttransplant graft function” in the main auditorium in the ‘Clinical Oral Presentations’ session. Dr Sarah Fawaz presented “Circulating TNFα, TNFR1 and TNFR2 Levels in deceased donors negatively associate with posttransplant kidney function” in the ‘Basic & Translational Science Oral Presentations’ session. All of which stimulated very engaging and interesting discussions.

I was honoured to have my abstract, “Oxygenated hypothermic machine perfusion (HMPO2) of the pancreas; comparing a ‘continuous’ and an ‘end-ischaemic’ approach in a porcine circulatory death model,” invited to be presented at the prestigious ‘7 of the best’ session. This was the result of a challenging set of experiments which have now paved the way to ongoing work supported by the QUOD whole organ research initiative.

The congress hosted a delightful drinks reception at the end of the first day and later on a vibrant themed gala dinner celebrating World Book Day. Throughout the event, networking was easy and engaging around the many industry and partner booths, including the QUOD booth staffed by Dr Sarah Cross and Philippa Wren. Overall, the congress was a great success, with excellent talks covering a wide range of multi-disciplinary interesting topics under the guise of transplantation.

QUOD’s British Transplantation Society (BTS) 2024 Overview

QUOD attended the BTS Congress in Harrogate from 6-8 March. The annual congress brought together over 500 attendees and from our exhibition stand we were able to meet and connect with researchers, nurses, surgeons and clinicians, as well as charity and industry representatives and NHSBT staff in a wide variety of roles. Having the opportunity to talk to so many people involved in the QUOD programme from across the UK, as well as researchers who have previously or are currently using QUOD samples was so valuable. We were also able to raise awareness of the bioresource and highlight its value to potential future users.

QUOD had a large presence throughout the congress. In the ‘Diversity in Transplantation’ session, QUOD Steering Committee members Colin Wilson and Isabel Quiroga debated for and against ‘Women in Transplant: There are barriers to progressing in transplant surgery’. In the same session Menna Clatworthy, whose group at the University of Cambridge have received QUOD samples for a few research projects, participated in the panel discussion on ‘Socioeconomic, gender and ethnic diversity’. In the Basic Science session on ‘Combating aging’, QUOD National Operational Coordinator Sarah Cross presented an update on QUOD activity and highlighted some exciting work from several QUOD supported research projects in the area of organ aging.

Research using QUOD samples was presented in a number of presentations during the congress. In the prestigious Medawar Medal session, Stephanie Chong from UCL presented her work ‘Composition of the neutralising antibody response predicts risk of BK virus viraemia in renal transplant recipients’. QUOD has supplied Stephanie with donor serum and spleen samples to help facilitate this project and it was terrific to see the results being showcased in this notable session. Two biomarker studies in kidney transplantation which used QUOD donor plasma samples were presented by researchers from the University of Oxford. In the ‘Clinical Oral presentations’ session Ioannis Michelakis talked about his study ‘Donor Cystatin-C association with post-transplant graft function’. In the ‘Basic and Translational Science Oral presentations’ session Sarah Fawaz presented her work ‘Circulating TNFα, TNFR1 and TNFR2 Levels in deceased donors negatively associate with posttransplant kidney function’. In the ‘Calne Williams Medal presentations’ session, the latest developments from the OrQA project, of which QUOD is a collaborative partner, were presented by Georgious Kourounis from Newcastle University ‘Organ Quality Assessment for Livers (OrQA-L): Real-time visual assessment of steatosis during retrieval using machine learning models’.

As is BTS tradition, the gala dinner for this year’s congress had a theme, and due to it falling on World Book Day, delegates arrived dressed up as fictional characters ranging from Moby Dick, Gandalf and the Hobbit and Red Riding Hood, to a swarm of Where’s Wallys! It was a hugely enjoyable evening that ended with us dancing the night away on a packed dance floor to a particularly good live band.

We would like to thank BTS for its continued support and look forward to the 2025 congress where we can showcase more of our scientific collaborations and impact.

QUOD Whole Organ Expansion

In 2018, a multi-disciplinary team of researchers from Oxford and Newcastle, led by Professor Rutger Ploeg and Professor James Shaw, was awarded a grant of £1.7 million from the Medical Research Council (MRC) to enable the expansion of QUOD to establish a whole organ tissue bank.

This funding enabled the central QUOD clinical data, blood / urine sample and tissue biopsy Bioresource in Oxford to be augmented by systematic processing of whole organ pancreas, heart and lungs from deceased organ donors to collect anatomically-driven mutimodal biopsies. This grant allowed QUOD to establish cross-cutting scientific platforms including state-of-the-art pathology, transcriptomics, proteomics and light / multiplex fluorescence / EM imaging. The QUOD-PANC tissue bank at Newcastle University has archived samples from 120 donors within a searchable online Atlas comprising from normal, ischaemic and chronically diseased pancreata. Underlying pathologies include type 1, type 2 and type 3c diabetes in addition to chronic pancreatitis and pancreatic intraepithelial neoplasia (PanIN).

About QUOD Whole Organ Resource

The QUOD whole organ expansion programme at Newcastle University is coordinated by scientists and clinicians including Professors James Shaw, Andrew Fisher, John Dark, Dina Tiniakos and Dr Bill Scott. Quality-assured tissue processing is undertaken by dedicated biomedical scientists led by Minna Honkanen-Scott within the Transplant Regenerative Medicine Laboratories at the International Centre for Life. Professor Paul Johnson leads a parallel research pancreatic islet isolation programme at the University of Oxford.

QUOD Expand facilitates integration of high-quality clinical data, circulating biomarkers and deep molecular phenotyping towards deeper understanding of the stresses associated with organ donation and transplantation together with the mechanisms underlying tissue pathologies. The overall goal is development of novel therapeutic strategies to optimise organ transplantation, tissue replacement therapy and in situ endogenous tissue repair.

(H&E stained image of an islet. 40x magnification)

Following dissection from surrounding tissue, the whole organ is assessed and photographed macroscopically before collection of multimodal biopsies from anatomically defined regions. Light microscopy images are obtained following a standard suite of dye and immunohistochemical stains for clinical pathologist assessment and Artificial Intelligence-driven image analysis (led by Professor Sarah Richardson, Exeter University). Standardised ultrastructural assessment by transmission electron microscopy has been validated.

The whole organ expansion programme has benefitted significantly from an NHSBT initiative Increasing the Number of Organs Available for Research (INOAR) which has included pancreata from donors with diabetes.

The QUOD expansion programme is aligned to the overall QUOD mission: ‘Saving lives and cutting health care costs by increasing the pool of transplantable organs, thereby addressing the growing gap between supply and demand in organ transplantation’ and provides a powerful new resource for disease-specific research.

QUOD Panc Atlas

An online Portal is in development providing access to a library comprising donor data; organ / tissue images; AI analysis; and a catalogue of samples available for research within the Quality in Organ Donation whole organ human pancreas tissue bank – QUOD-PANC.

The goal is to establish, curate and share a unique Bioresource representing the range of normality, acute stress and chronic disease within human pancreas – in parallel with access to detailed donor clinical data and quality-assured clinical pathologist reporting.

Integration with the core QUOD Biobank enables parallel access to donor circulating blood and urine samples in addition to small biopsies from other tissues.

The Portal provides access to organ donor clinical data in parallel with macroscopic and microscopic pancreas images. Multimodal samples from each anatomically defined region (8 in total from head to tail of pancreas) comprise: Formalin Fixed Paraffin Embedded tissue blocks (anterior and posterior) / snap-frozen tissue blocks / bulk protein samples / RNAlater samples / glutaraldehyde-fixed samples for EM. Sample details are catalogued for each donor.

Initial requests can be made through the Portal for samples to be processed centrally or released for approved research.

Researchers wishing to access QUOD samples should submit a preliminary registration online for Administrator approval and if successful submit a relevant project for review.

Contact us at atlasportal@ncl.ac.uk

For further information on the work being undertaken in Newcastle please go to Regenerative Medicine, Stem Cells, Transplantation | Faculty of Medical Sciences | Newcastle University (ncl.ac.uk)       

New QUOD Colleague Questionnaire:

Kerry Clare – Oxford Transplant Biobank (OTB) Coordinator & QUOD Oxford Regional Operational Coordinator

What were you doing most recently before joining QUOD and OTB?

I was working within the Oncology & Haematology department at the Churchill Hospital, Oxford as a Clinical Coordinator.

What interested you about working with QUOD and OTB?
I have previous experience with haematology and lab work and thought a role within a research biobank sounded interesting and rewarding.

What does your role involve?
I am the Senior Biobank Coordinator for OTB & QUANTUM biobanks and the Regional Operational Coordinator for the Oxford region for QUOD. I retrieve and process donor samples, ensure accurate entry of details into the respective biobank databases and am responsible for the smooth running of the sample collection and storage process.

Lightning round time:

If you were stuck on an island what three things would you bring?

My dogs, a fishing net and matches.

Where’s your favourite place?
Cornwall – many memorable family holidays.

Finally, what kinds of enquiries should people bring to you, and how best can they reach you?

Any sample collection and/or processing enquiries for OTB, QUOD and QUANTUM biobanks. Email kerry.clare@nds.ox.ac.uk.

Spotlight on a QUOD Colleague – Dan Eggleston

For this edition of the QUOD newsletter, the spotlight shone on Daniel Eggleston who is a Senior Clinical Scientist within the field of Histocompatibility and Immunogenetics (H&I) at the Manchester Royal Infirmary and a Regional Operational Coordinator (ROC) for QUOD.

Dan’s first foray into the field of organ transplantation began following his undergraduate studies in Biochemistry at Royal Holloway University, where it became clear that he wanted to pursue the applied sciences more. He completed a master’s degree in Transfusion and Transplantation Science at Bristol University before joining Anthony Nolan, a charity dedicated to matching potential donors on a growing stem cell register to patients with blood cancer and blood disorders. The organisation also facilitates research working towards improving survival rates and quality of life after transplantation, providing post-transplant care.

When asked what advice he would give to any graduate students looking for a foothold in the applied sciences, which is often competitive as entry level positions are highly sought-after, he advised reaching out to relevant companies, making connections and being persistent. Dan also recommended tailoring the application to focus on experience garnered while completing University projects that are relevant to the skillset outlined for the position.  

As a Senior Clinical Scientist for a H&I laboratory, Dan uses Polymerase Chain Reaction (PCR) techniques to identify patient and donor Human Leucocyte Antigens (HLA) supporting organ transplantation (such as kidney, heart, lung, islet and pancreas), as well as stem cell and bone marrow transplantation, of which Dan is a donor himself. Dan can often be found on call, assessing the HLA type of a potential deceased organ donor, and creating a crossmatch or compatibility assessment to test if an organ from a potential donor can proceed to transplantation. Dan finds the on call work the most rewarding aspect of his role, though he has noted how challenging it can be during this time when balancing all the different offers of transplantation from potential donors across the country and trying to help as many patients and potential transplant recipients as possible following delays attributed to the COVID-19 pandemic. 

When not using his favourite piece of equipment in the lab, a PCR system for rapid cycling and tissue typing called the LightCycler, Dan supports the work of QUOD as a Regional Operational Coordinator (ROC) with Manchester being one of the regional centres for the biobank. This role involves taking receipt of QUOD boxes from the Manchester organ retrieval team, then centrifuging, aliquoting and freezing the blood, urine and bronchoalveolar lavage (BAL) samples, and shipping the box containing tissue biopsies to the hub at Oxford. Dan is also responsible for adding information from the QUOD worksheet to the QUOD database, which is integral for maintaining the traceability of the samples collected from a particular donor. Further to this, Dan has recently become the ROC representative on the QUOD Steering Committee. Part of this role is to provide feedback on research proposals submitted to QUOD. Dan remarked how interesting he finds this work as it shows where the samples, that he is involved in processing, are being used. He can then feed this information back to the team based in the H&I lab in Manchester, so they can stay well informed regarding the application of the biobank samples to current research.

In the last year, Dan has become a committee member for the British Society of Histocompatibility and Immunogenetics (BSHI), a national, professional body formed over thirty years ago that represents and supports the network of H&I laboratories across the UK. The objectives of the society are to encourage the advancement of scientific research and understanding of the application of these developments, as well as ensure the highest professional standards of competence are met by providing guidelines for best practice, training opportunities and CPD schemes for career progression. To this end, Dan has also taken part in a Higher Specialist Scientific Training Programme, funded by NHS England, all about leadership in healthcare. Dan also mentioned how he is looking forward to the next BSHI conference which is due to be held where he is based in Manchester next year.

Dan’s dedication and interest in facilitating transplantation research extends beyond his professional work, as he has helped raise money for Kidneys for Life, a Manchester-based charity which focuses on funding research into kidney disease, transplantation, in addition to supporting renal and transplant patients. Additionally, Dan took part in ‘Race for Recipients’ as part of National Organ Donation week, in order to raise awareness and to honour organ donors, recipients and those waiting for a lifesaving organ transplant.

Although he no longer captains a softball team in a charity league, which was a pastime during this time at Anthony Nolan, Dan likes to spend his spare time (when not on call) playing squash, going for a run or playing video games.

European Society for Organ Transplantation (ESOT) Congress September 2023

QUOD attended the ESOT Congress in Athens, Greece from 17th-20th September. This biennial congress brought together over 2800 attendees from across the world and we were able to meet and connect with a wide variety of delegates from our exhibition stand. Importantly, research using QUOD samples was presented in over 10 oral presentations and posters during the congress.

Out of more than 1000 abstracts that were presented, the Liver Atlas study, carried out by Hussain Abbas at the University of Oxford using QUOD liver samples, was included as one of only 11 abstract presentations as a ‘Scientific programme highlight’ in the ESOT Congress review: “Development of a novel ‘Liver Atlas’ to predict pre-retrieval steatosis may help to avoid discarding liver tissue – A novel, large-scale ‘Liver Atlas’ developed in the United Kingdom supported the use of pre-retrieval steatosis predictors and routine retrieval biopsy to avoid unnecessary viable liver discards”. To find out more, see page 16 of the ESOT Congress 2023 Review.

Dr Ivan Hartling, from the Big Data Institute at the University of Oxford, attended the congress to present his work using QUOD samples. Please see his summary below:

The European Society for Organ Transplantation (ESOT) Congress was held in Athens, Greece from 17th – 20th September 2023. Additionally, on Saturday 16th, before the official start of the congress, there was an ESOT Science Day that featured a great series of basic science talks. The congress theme, “Disruptive Innovation, Trusted Care,” emphasized how innovation can improve access to transplantation.

Dr Maria Kaisar encouraged all our team members to submit abstracts to ESOT and travel to Athens. We were delighted that all our abstracts were selected for oral presentations and we were well represented at the congress. We presented a series of abstracts using QUOD samples to investigate how proteins in kidney donors associate with and predict kidney function post-transplant. Dr Philip Charles presented his work on “Age-Modulated Proteomic Signatures Of Donor Kidney Biopsies Associate With Below-Median 12 Month Outcomes”, Dr Sarah Fawaz presented “Circulating TNF-alpha levels in deceased donors associate with post transplant function in Kidney Transplantation”, Dr Ioannis Michelakis presented “TNF-α pathway activation on deceased kidney donors: a critical mediator of unfavourable post-transplant outcome”, and Rebecca Vaughan presented two abstracts, one titled “Changes In Endogenous Peptides In DCD Kidney Biopsies Associate With Prolonged Warm Ischaemia” and the other “Biological Injury Associated With Deceased Donor Pathways Reflect Differences In The Donor Kidney Proteome And Cellular Stress Responses”. 

I was honoured to have my abstract, “Identification of donor protein signatures that predict kidney transplant outcomes – ADMIRE study,” accepted as a late-breaking abstract. Both Dr Michelakis and myself presented in an early Monday morning session. Despite the early hour, the audience was alert, attentive, and asked many questions. 

As it was my first in-person conference in a few years, I was thrilled to have the chance to network with other researchers. The congress hosted a delightful wine and cheese evening, and throughout the event, attendees could mingle around the many industry and partner booths, including the QUOD booth staffed by Dr Sarah Cross and Philippa Wren. Overall, the congress was a great success, with excellent talks covering all aspects of transplantation. I am looking forward to the next ESOT congress, which will be held in London from June 29 to July 2, 2025.

The Evolution of a QUOD Box

Bespoke, ergonomic and unique to the Quality in Organ Donation (QUOD) biobank, the QUOD sample collection boxes are critical to the transportation of donor blood, urine and tissue collected by nurses and retrieval teams. Sample collections are taken at four different time points across the donor management period, all the way through to the point of organ retrieval.

Manufacture

These custom-made sample collection boxes are assembled by hand and distributed nationally from the Oxford hub by QUOD Technical Assistant, Sophia Ali. Sophia joined the team four years ago and she continues to ensure that the Specialist Nurses in Organ Donation (SNODs) and retrieval teams across the UK are well-stocked with QUOD boxes, as well as other essential resources needed in theatre for sample collection. This can include biopsy punches and other equipment to aid in processing samples in the lab. “The most vital piece of kit which I am responsible for building and supplying across all hospitals in the UK”, she says, “is the famous QUOD box.” Watch a video demonstration of Sophia constructing a QUOD box [here] or read the step-by-step process from Sophia below.

How to build a QUOD box by Sophia Ali

“The QUOD box is made up of several components. You start with the outer box which is initially flat packed. Our vibrant QUOD sticker as well as the receipt and map sticker are applied. At the back of the box, we store the two information sheets, one for Scotland and one for England, Wales, and Northern Ireland along with the consent sticker.”

“Inside the box you will find individual red, green, blue, and yellow foams. Each foam represents a separate component and holds a different sample from the donor. The red foam will hold twelve blood tubes – six EDTA, three Heparin and three SST tubes. All are barcoded to identify the collection at separate time intervals. In the yellow foam you will find the BAL tube, three urine tubes and one (orange top) spleen container filled with RNAlater preservative. The green and blue foams contain the five tissue tubes. In the blue foam, the five tissue tubes are filled with formalin and the green, with RNAlater preservative. We currently collect liver, left kidney (in formalin), right kidney (in RNAlater), ureter, right heart ventricle and left heart ventricle. Each box will contain a worksheet where each sample collection can be recorded, and any variance notes can be added. There will also be DB1 and DB2 collection for blood serum in the preliminary stages of donation. Each box will be labelled with a unique barcode to ensure complete traceability. I also make note of where each box is shipped to via this barcode.”

Shipping

On a typical working day Sophia will respond to e-mail requests from SNODs and regional centres, subsequently building each QUOD box and packaging consumables accordingly, ready for shipping: “Due to demand, I have to make sure I have enough material to fulfil all requests. I aim to complete all requests within two working days”. During her time at QUOD, Sophia has calculated that she has built and distributed approximately 4,250 QUOD boxes since 2019! With the rising cost of consumables in recent years, the cost to produce and ship one QUOD box is currently around £60.00 GBP.

From retrieval to research

Tissue biopsies are stored in two different types of media for transportation to preserve the tissue in the best way possible whilst allowing for the widest variety of techniques to be carried out in future studies. Each sample has a unique identifying barcode which is recorded on the QUOD database to preserve traceability and donor anonymity throughout the whole process. The QUOD database links clinical donor information to these samples, allowing researchers access to samples that meet the requirements of their research.

Evolution

The current design represents years of continual evolution and improvement (as pictured), in accordance with changes to legislation from the early stages of QUOD to today. 2023 marks a ten-year milestone which we have honoured with a new logo that can be seen on each QUOD box.

Sophia remarks how the design is under constant review and has seen major changes in recent years, including changes to tissue collection and corresponding changes to the worksheet. Most recently being the change to kidney biopsies, whereby the biopsy from the left kidney goes into formalin, with the biopsy from the right kidney being preserved in RNAlater. Previously, biopsies from each kidney were divided in two, with each half going into formalin or RNAlater. There have also been changes to the sizes of heart and kidney biopsies over the years, in response to feedback from retrieval teams who collect the samples, researchers who use the samples and results from internal quality assurance audits.

A decade of QUOD marks a time of reflection for the whole team, as we look back on the evolution of the biobank over the last ten years and think about all the people who have helped us reach this landmark. We look forward to celebrating this achievement with our wider QUOD family throughout the year and most especially at our symposium on Friday 8th December 2023 at Exeter College in Oxford.

British Transplantation Society 2023

From QUOD to Scotland: QUOD travelled to Edinburgh for the 50th anniversary of the British Transplantation Society (BTS).

In March, QUOD Research Assistant, Dr Hannah McGivern and Technical Assistant, Sophia Ali journeyed up to Edinburgh for the Joint Congress hosted by the British Transplantation Society (BTS) and NHS Blood and Transplant (NHSBT). This year, delegates were able to celebrate the 50th Anniversary of the BTS and showcase the latest developments in the fields of organ donation and transplantation.

The conference provided a great opportunity to speak with so many of our colleagues from across the QUOD consortium, including Specialist Nurses in Organ Donation (SNODs), retrieval teams, clinicians and researchers, answer questions and listen to feedback.

When asked about her experience after attending her first conference as a representative of QUOD, Sophia commented on how great it was to meet the wider QUOD network: “I communicate with all the SNODs and NORS teams through e-mail, so meeting them in person was lovely. They gave lots of positive feedback about QUOD and how it has been working well over the years in donor hospitals. SNODs enjoy being part of the process and knowing how the work we do day to day can bring forward some ground-breaking research. It was great to speak to the people who handle the QUOD boxes after I have shipped them, to hear what their roles are in QUOD and to listen to them speak about their own personal experiences during the many stages of the QUOD sample collection process. They were also incredibly surprised that each QUOD box that they have handled is built by me!”

QUOD was honoured to be included in the opening keynote lecture on ‘Predicting the Future – Technologies to Inform Organ Utilisation’ delivered by Professor Menna Clatworthy, University of Cambridge. Furthermore, we were delighted to meet with healthcare professionals and researchers who have utilised QUOD samples as part of their research studies that were presented at the congress.

On the final day of the conference, QUOD Principal Investigator, Prof Rutger Ploeg and Basic Science Co-ordinator, Dr Maria Kaisar delivered a presentation as part of the UK Organ Donation and Transplantation (ODT) Research Network session, acknowledging the ten-year accomplishments of the biobank as well as recent collaborations and exciting new developments.

New QUOD Colleague Questionnaire

Dr Ana Gil-Bernabe – Quality & Governance Manager for QUOD and QUANTUM Biobanks

What were you doing most recently before joining QUOD?

I worked in the Human Tissue Governance group, which is part of RGEA (Research Governance, Ethics and Assurance), within Research Services at the University of Oxford. This was a research support role focused upon ensuring that work with human tissue at the University of Oxford is performed in compliance with the UK legislation and the Human Tissue Licence conditions. Basically, the aim was to allow the progress of science within the legal and ethical boundaries that regulate clinical research.

What interested you about working with QUOD?

During my time in the Human Tissue Governance group, I interacted with the eight biobanks that operate under the main Human Tissue Licence at Oxford, including both QUOD and OTB. This was a great opportunity to understand what a fantastic research resource biobanks are for researchers, here and abroad, and how they optimize their very valuable samples that are donated to the biobanks. QUOD is a fantastic example of national and international collaboration, with samples collected and delivered to multiple sites. I understood that it was a great opportunity to apply my acquired knowledge on human tissue governance and quality assurance, as well as to progress on my knowledge on human tissue biobanks and their governance. Last, but not least, I do have a passion for research (I have been a researcher for about 15 years) and the field of transplantation is very close to my heart.

What does your role in QUOD involve?

In a nutshell, ensure that QUOD adheres to the legal and ethical frameworks that regulate clinical research in the UK, in particular the Human Tissue Act 2004, and to the conditions of the Human Tissue Licence at the University. QUOD Governance is transitioning to a Quality Management System, iPassport, to make this task easier, and part of my role will be to support this transition. We will use iPassport to manage our governance documents, run audits, report non-compliances and keep training records, for example. I will also support compliance with other frameworks that relate to clinical research, such as the Health Research Authority or the Research Ethics Committees.

Lightning round time:

If you were stuck on an island what three things would you bring?

  • Documents, of course, any activity needed would be well described in the relevant Standard Operating Procedures (SOPs);
  • iPassport, of course, all those documents will be accessible through iPassport;
  • Nothing else, I love the sea, so I’d enjoy the opportunity to swim and explore the island.

Where’s your favourite place?

It could well be that island, but probably my hometown, Cadiz, as it not only has a lovely coast, but also all the ingredients for happiness: family, friends, good weather and good food. In its absence, any place near the sea, with the sound of the waves and the smell of the salty water.

Finally, what kinds of enquiries should people bring to you, and how best can they reach you?

Anything to do with governance and quality assurance: documents (SOPs, Risk Assessments, Working Instructions), audits, non-compliances and training records, for example. As we transition to iPassport, I imagine many questions will be related to the use of this system.

You can reach me at ana.gil-bernabe@nds.ox.ac.uk and I’m setting up other ways of communication, using Planner and Teams – more information to come!

QUOD & Evotec: An academia-industry partnership built on complementary strengths

Tobias Bohnenpoll, Evotec SE

Evotec SE and the University of Oxford have recently renewed their collaboration agreement, reflecting a robust and sustainable partnership to profile tissue biopsies collected, processed and stored by the QUOD programme. Through this partnership, Evotec has already generated genome-wide bulk transcriptomic data from about 2,000 donor biopsies (895 kidney and 910 liver), complementing the rich clinical records and technical metadata collected by NHSBT and QUOD. Evotec is currently extending the analysis to heart biopsies and high-resolution single cell and spatial transcriptomics, which will allow in-depth molecular characterisation of tissue microenvironments. Together, we aim to generate mechanistic insights to improve the quality of organ donation and transplantation, and to identify targetable mechanism of injury and repair that will open new avenues for therapeutic intervention and patient stratification in metabolic, cardiac and renal diseases.

The multimodal characterisation of organ biopsies using state-of-the-art, high-throughput analysis is an important cornerstone of Evotec’s Molecular Patient Databases (E.MPD), an industry-leading, proprietary collection of curated human datasets for translational research and patient-centric target and biomarker discovery. However, the integration of complex clinical and molecular data into curated multidimensional datasets poses great challenges to scientific teams and requires interdisciplinary approaches. Evotec and QUOD researchers have assembled an expert team that efficiently combines domain knowledge in medicine and biology with high-throughput molecular analysis and modern data science. Together, we are exploring the complex relationships between biopsy molecular profiles, donor and recipient clinical phenotypes, and graft outcomes in all major organ recovery and transplant conditions. This exploratory analysis of biopsy transcriptomes involves unsupervised clustering, dimensionality reduction and embedding of clinical data and molecular signatures to enable a data-driven hypothesis generation.

Importantly, the multidimensional characterisation of QUOD biopsy transcriptomes has enormous potential beyond research in organ donation and transplantation, with direct applications in modern drug discovery. First, samples from healthy organ donors that are obtained from the Oxford Transplant Biobank (OTB) can serve as reference for the molecular analysis of other disease-focused prospective cohort studies, which often lack appropriate controls. Second, organ donors often present with early, subclinical disease phenotypes that potentially provide unique insights into the onset and early progression of metabolic and other common diseases. For example, Evotec has integrated a data-driven selection of QUOD and NURTuRE (National Unified Renal Translational Research Enterprise) kidney biopsy transcriptomes ranging from healthy to end-stage chronic kidney disease to model disease initiation and progression at the molecular level. We are also combining transcriptomic analysis with AI-assisted digital pathology to characterise liver biopsies for steatosis, inflammation and fibrosis and determine their position along the spectrum of fatty liver disease.

Ultimately, these systems biology approaches aim to positively impact the lives of patients with organ transplantation, cardiometabolic diseases and related complications by leveraging advanced molecular analysis and interdisciplinary expertise. This transformative work is only possible through close collaboration between academia and industry, combining their strengths and resources to achieve meaningful advances in knowledge that will help improve patient care and therapeutic intervention.

Spotlight on a QUOD Colleague

William Murray

This year, QUOD is celebrating its ten-year anniversary and for this edition of the QUOD newsletter, I was delighted to speak with William Murray who has been a Specialist Nurse in Organ Donation (SNOD) for NHSBT since the inception of QUOD back in 2013 in Edinburgh, Scotland. QUOD has now collected over 128,000 samples from more than 7,000 donors, supplying in excess of 38,000 samples to more than 55 research projects. This milestone would have certainly been insurmountable without the extraordinary efforts of this national consortium, including the Specialist Nurses who have such a critical role in the process.

William describes his role as a SNOD for NHS Ayrshire and Arran as multifactorial. He explains how the Specialist Nurses manage the process of organ donation from the point of referring a potential organ donor, working with colleagues in the intensive care units (ICU) and being present in theatre during retrieval. The SNODs are also responsible for the clinical management of the donor to ensure the stability of the patient all the way through the retrieval process through to family after-care. This includes speaking with the families or next of kin of the patient regarding consent/authorisation for research and the collection of samples for the QUOD biobank. William notes that the key to being a SNOD is communication, empathy, forming a rapport with people and using your instinct to judge what is right for every family member going through what is a very difficult time in their lives.

William explains how the respect and dignity to the families’ loved one is upheld and in the foremost thoughts of those involved during the process of obtaining samples for research purposes and that taking biopsies for QUOD does not affect the efficacy of the organs upon transplantation. Sample collection for QUOD closely mirrors the sampling required for the donation process and families are already aware that blood and urine is routinely analysed from patients while in hospital. William notes that the QUOD process works well because it has been built around the systems that already exist in the hospital.

When asked what advice he would give to any nurse or clinician considering specialising in organ donation, he advised to not lose sight of the unique relationship between the relative or next of kin and the patient, that the bond between a couple or parent and child does not change regardless of age and to be mindful of this.

The work that William does for QUOD is in fact a relatively small aspect of his day-to-day routine. He talks about how SNODs spend much of their time on call, covering the region that they work in which can often be a very large geographical spread. For William, this can include the whole region of Scotland! When not on call, William says that his focus is on teaching and raising awareness in addition to clinical audit and policy development. The latter includes identifying potential limitations or barriers to organ donation and working closely with clinical colleagues and committees to design and implement policies that address these barriers.

William remarked that change in his role is almost constant as incremental changes often occur on a weekly basis in reaction to clinical outcomes. William also discussed the interest in supporting organ donation and changes that he observed following the Government Campaign in Scotland, ‘Do Not Leave Your Loved Ones in Doubt’, which urged the public to register their decision with regards to the NHS Organ Donor Register and to speak about their decision with their families.

To close, William observed how being a SNOD is a complex role, helped by technological advancements with more information leading to better outcomes, very hard work but also incredibly rewarding; a unique position which gives him the opportunity to bring about meaningful change far and wide, and yet still work on a local level in the ICU, which is very important to him. He remarked how privileged he felt to work in a role that can help patients and their families across the UK, “What I do in Ayrshire, makes a difference at a national level”. Having started his career as an intensive care nurse, William says that “the intensive care unit is in my bones” and speaks warmly of the camaraderie and community embedded in the ICU and the connection amongst the SNODs.

A special thank you to all the SNODs across the UK, along with all the clinicians, retrieval teams, surgeons and technicians that have enabled QUOD to reach this monumental milestone!

William Murray was interviewed by Hannah McGivern.

Announcing the ‘7th National QUOD Symposium’

This year’s QUOD Symposium is extra special as 2023 marks the 10-year anniversary of the QUOD programme.

The symposium will include scientific updates, collaborative discussions and strategic planning, with talks from speakers spanning the entire QUOD consortium. We will take a look at the past 10 years, QUOD’s present endeavours and future plans.

Everyone is welcome to join us in these celebrations on Friday 8th December 2023 at Exeter College, University of Oxford.

Please see the invitation and current draft programme below:

To secure your place please complete the registration form here.

QUOD 10-year anniversary and 7th National Symposium
QUOD 10-year anniversary and 7th National Symposium Invitation
Draft QUOD Symposium Programme 2023 for website v1

New QUOD Colleague Questionnaire

Thomas Vermeire – Project Manager

What were you doing most recently before joining QUOD?
I was living in Brussels where I worked as a Programme and Project Manager at a health insurance company. This mainly involved working on organisational, development projects and programmes.

What interested you about working with QUOD?
I have always looked for roles in impactful organisations. When I found the QUOD job posting, I was immediately convinced: supporting research to improve transplantations and help more patients is a magnificent goal to participate in.

What does your role in QUOD involve?
My main focus is to have an overview of all projects and make sure that they run within time, budget and scope. Also, I will be helping our scientists to set up new, impactful projects and commercial partnerships.

Lightning round time:

If you were stuck on an island what three things would you bring?

  • A survival kit: there is no fun on an island if you are not able to survive.
  • Seeds to plant: growing vegetables and fruit will provide food and is also a good way to spend time.
  • A pair of good hiking boots: to explore the island.

Where’s your favourite place?
At home in my little vineyard back in Belgium, where I am learning to grow grapes and make my own wine.

Finally, what kinds of enquiries should people bring to you, and how best can they reach you?

Anything related to project management and viticulture. I can be reached at thomas.vermeire@nds.ox.ac.uk.  

Spotlight on a QUOD Colleague

Professor Lorna Marson

For this edition of the QUOD newsletter, the spotlight shone on Professor Lorna Marson. I was delighted to speak with the new Associate Medical Director for Research and Development at NHSBT about her distinguished career.

Spotlight on a QUOD Colleague

Lorna started her medical career as an undergraduate student at St Thomas’ Hospital, London which was then a much smaller medical school with an annual intake of only 90 students. Although she enjoyed all aspects of her studies, it was during her time in London when there were very few female surgeons, that her interest in surgery piqued. Unfazed, she was even more determined to pursue a career in surgery, training in local district general hospitals and thriving. She spoke fondly of the sense of community she felt during her time working with the wider team, including a year of training in Dumfries.

However, it was working in the national transplant centres in London and Edinburgh that afforded more opportunities for Lorna to be involved in transplant research and train as an academic. When asked what pearls of wisdom she would pass on to early career researchers, she advised to be open to new opportunities outside your comfort zone and try not to have tunnel-vision in view of where you expect your career to go.

Although at first, a self-proclaimed “reluctant researcher”, Lorna enjoyed taking time out of her clinical work to pursue her research interests. She remarked how she had wanted to dedicate time to aligning with scientists to establish a high-quality and unique research programme, at the same time as being an excellent clinician for the benefit of her patients. Lorna spoke highly of the mentorship, welcome and guidance she was given by Professor Sir John Savill, Professor Jeremy Hughes, and Professor Sir Peter Morris, from learning about technically challenging renal transplant models to the role of macrophages in early kidney injury. We discussed their impact and support during the formative and later stages of her research career, and the honour she felt in collaborating with them.

In addition to her own research commitments, Lorna has been intrinsically involved with QUOD, working closely with Professor Rutger Ploeg. She spoke of the very challenging but immensely rewarding experience of being involved in the early development of the biobank in Scotland, and that the next stage is to optimise its benefits, promote accessibility and ensure that the governance remains robust. The aim is to set the precedence of the UK as an exciting place to undertake research in transplantation for industry and academia, aligning the transplant timeline with recipient data to get a more complete picture of what happens from donation onwards. Lorna views her new role as an exciting prospect, including managing the relationship between QUOD and NHSBT, providing an academic oversight for the OTDT clinical trials unit, as well as reviewing and meeting the OTDT 2030 strategy. This includes addressing health inequalities in organ donation and transplantation and ensuring that there are effective and relevant patient outcome and experience measures in place.  

Aside from her clinical and academic roles, Lorna is the College Dean of Admissions for Edinburgh Medical School. As a result, she plays an integral role in shaping undergraduate, postgraduate, and doctoral experiences at the University. As the school’s lead for Diversity and Respect, Lorna hopes to broaden the socio-economic and ethnic landscape of the student population in this historic institution. She spoke earnestly about the need for the medical workforce to reflect the community they serve, to providing an open atmosphere where students facing financial hardship or challenging times can ask for help, and that there is a support network in place to assist. It is critical to support parents of young children in the profession, having received such support when her own children were very young: “By providing this support for a small number of years, they will then deliver”. Looking to the future, Lorna wishes to address the urgent disparity in gender within surgery, and provide support to ensure that students succeed and flourish in their career endeavours.

To add to her accolades, Lorna was elected as the first female President of the British Transplantation Society (BTS) in 2017, which she said was a huge honour. The society celebrated its 50th anniversary at the 2021 congress which Lorna attended in Belfast. She spoke warmly of the experience, returning to face-to-face interactions, stating that it was a “brilliant reminder of why we work as hard as we do to transform transplantation”. She also spoke of her delight that students and trainees had a platform to present and share their research, with some contending for medals. Lorna hoped going forward that more scientists will be encouraged to attend the society conferences and continue to enrich the discussions and collective sharing of ideas between researchers and clinicians, all ultimately to benefit patients in the future. Furthermore, Lorna remarked that the 50th anniversary was a time of reflection and an opportunity to look forward optimistically about the future of transplantation, in the hands of the next generation of scientists and clinicians: “[We need to] make sure that they are involved in the strategic progression of the field and nurture the future leaders of the profession”.

A keen open water swimmer and cyclist, Lorna can also often be found running with her 18-month-old Labrador in tow around the rural outskirts of Edinburgh. Her passion for the outdoors and exercise in general, she says, is essential for her mental health and wellbeing. A budding triathlete, Lorna looks forward to her next challenge…an even bigger triathlon!

Professor Lorna Marson was interviewed by Hannah McGivern

Spotlight on a QUOD Colleague – Professor Colin Wilson

For this issue of the QUOD newsletter, we caught up with Colin Wilson, Professor of Transplantation and Hepato–Pancreato–Biliary (HPB) Surgery at Newcastle University, NHS-employed Consultant Surgeon, and QUOD Principal Investigator for Newcastle. We spoke to Colin about his academic and clinical roles in transplantation as well as his role within the QUOD programme, including how QUOD is supporting the development of a novel artificial intelligence (AI)-informed assessment of organ quality.

In his role as QUOD Principal Investigator for Newcastle, Colin coordinates specimen collection and onward transport to Oxford. He works with various teams within the Newcastle-upon-Tyne Hospitals Trust; the HPB team delivers the QUOD boxes to Oxford and the organ retrieval team underpins this. Colin actively supports the professional development of his team members and encourages their involvement with QUOD.

Colin leads a team at the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, which is a collaboration between Newcastle and Cambridge Universities. The programme involves clinical work and registry analyses to look at ways to improve organ utilisation and provide a scientific basis to develop policies in clinical practice around organ utilisation. The programme delivers work packages, protocols, projects, and trials. One such trial is OrQA (Organ Quality Assessment), which, in collaboration with QUOD, is developing a tool that uses AI-driven analysis of photographic images of organs (taken using devices such as smartphones) to predict their suitability for transplantation by assessing factors such as perfusion quality or percentage steatosis (in liver). Colin recalled his experiences as a child using his first camera, the rigmarole of taking the film to be developed, and the wait to receive the prints, whereas nowadays we all have very high-resolution cameras on our phones that could be applied to transform our approach to medicine. His enthusiasm for the use of technology to advance transplantation outcomes is clear and is just one of his visions for the future of transplantation.

Looking ahead, Colin is keen to support medical students aspiring to become transplant surgeons and is actively involved with the North East Surgical Training Academy (NESTAC) training and mentorship programme, which connects students and trainees with mentors. He considers himself to be extremely lucky to be able to support some of the very talented medical students who are interested in careers in transplant surgery. The pathway to becoming a consultant transplant surgeon begins with a one-year laboratory-based MRes project that is written up in a thesis and presented as oral and poster presentations, which may go on to be presented at conferences and meetings, followed by progression to academic foundation doctor (core training level), academic clinical fellow, and finally clinical lecturer. The programme takes around 10 years from start to finish and Colin is very much looking forward to seeing the first person “come off the conveyor belt”, who he first met as a medical student keen to become a consultant transplant surgeon. He has mentored and supported him throughout his career development and says “it is going to be a really big moment that I’m looking forward to”.

Colin’s own journey to become a transplant surgeon began in 1999, when he was working as a Senior House Officer on a gastroenterology ward with Oliver James, Professor of Hepatology, at the Freeman Hospital, Newcastle. It was here that he realised that liver transplantation was key to the successful treatment of many patients with liver ailments. In 2001, he began his PhD, supervised by Prof. David Talbot, on non-heart-beating kidney transplantation, which was novel and challenging work at the time. He then went on to complete his training as a Surgical Registrar from 2006–2012.

While transplant surgery can present challenges, Colin describes his job as rewarding and he is very much future-focused. He is driven by research, developing technology, and building strong teams, and most enjoys creating and delivering novel solutions to overcome (or work around) the hurdles and obstacles facing transplantation. His research aims to identify how to make the best use of the resources available, such as finding ways to overcome non-use of organs from deceased donors and achieve good long-term outcomes for patients, while prioritising safety. He is passionate about supporting the next generation of UK transplant surgeons, who will also face issues for patients with organ failure but may consider newer approaches such as the use of stem cells, AI, or xenotransplantation, which has been approved in the USA but is not currently implemented in the UK.

Colin is unquestionably proud of his hugely dedicated and committed team, comprising particularly talented members, all with broad-ranging areas of expertise and who have won numerous esteemed prizes for their work in transplantation, published cutting-edge research, and are developing “staggering” novel AI work. He mentors his team academically and it is hugely important to him to provide them with an environment in which they can flourish.

Colin describes the QUOD programme as “engaging and outward-looking”, and really values the focus it brings to transplant research. Of particular importance to him are the governance structures in place, in addition to the core biorepository work, as well as the fellowship among like-minded individuals who can build projects on top of the infrastructure that QUOD brings. “It’s not just what QUOD is, but what QUOD has allowed to build around it and the connections that has made it such a valuable resource for UK transplantation.” He believes that the UK is world-leading in many areas of transplantation and QUOD is at the core of that.

In addition to his work in Newcastle, Colin’s job sees him travelling to and presenting at national and international meetings. He will be co-chairing the ESOT Congress 2025 in London, which will focus on sustainability, not just in terms of climate emergency but also workforce and the issues and challenges facing the NHS and European healthcare systems that are struggling to deliver doctors, nurses, and specialists in transplantation.

While his work has taken him to various countries over the years, outside of his busy full-time clinical and academic roles, Colin cherishes time with his family, enjoying activities such as table tennis and travelling together, and is looking forward to a family holiday in the next few weeks.

Interviewed by Jenny Collins.

New QUOD Colleague Questionnaire:

Dr Jenny Collins – Tissue Handling Technician & Communications Officer

What were you doing most recently before joining QUOD? 

I had two part-time jobs before I started with the QUOD team. I worked in publishing, as a Managing Editor of an endocrinology journal and as a copy editor, and I also worked in a secondary school as a Science Technician.  
 

What interested you about working with QUOD? 
As well as my background in publishing, I previously worked at the University of Oxford in research. This role appealed as it gives me the opportunity to bring together my lab skills and publishing experience in an organ transplantation setting, which is hugely interesting and will have an enormous positive impact on people’s lives.  

What does your role involve? 

I receive biopsy samples from various tissues (heart, kidney, liver, and ureter) and process them for histology. The formalin-fixed paraffin-embedded samples are then stored in the QUOD Biobank until they are requested for research. When the samples are required for research, I then cut sections and prepare slides for histological analysis.
I will also be involved in public engagement and communications to help to increase awareness and visibility of QUOD and the incredible impact the biobank can have on transplant research.

Lightning round time: 

If you were stuck on an island what three things would you bring? 

 A radio, a knife, and a great book.

Where’s your favourite place? 
It has to be the Hermitage of Braid and Blackford Hill in Edinburgh. I grew up in Edinburgh and have a lot of great memories of family walks here, including rolling eggs down Blackford Hill at Easter, which has also become a family tradition with my own children.

Finally, what kinds of enquiries should people bring to you, and how best can they reach you? 

Any questions about tissue processing or communications can be sent to me via email: jenny.collins@nds.ox.ac.uk.