Spotlight

Spotlight on a QUOD Colleague – Dan Eggleston

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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.

Spotlight on a QUOD Colleague

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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.

Spotlight on a QUOD Colleague

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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.

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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 – Dr Bill Scott

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For this edition of the QUOD newsletter, the spotlight shone on Dr Bill Scott who is the Scientific Director of Transplantation and Regenerative Medicine at Newcastle University, liaising with colleagues in all transplant specialities, orchestrating the daily running of the labs with a focus on moving basic and translational research into clinical practice. Bill is a key member of the QUOD hub in Newcastle, formed during the MRC funded expansion of QUOD to include whole organs made available for research. This important steppingstone will form the basis of many more research projects and enable access to bespoke samples to help answer burgeoning questions posed by the wider transplant community.  

Bill has spoken of his interest in improving access to tissue for research purposes, which has led to his collaboration with QUOD. He commented on how QUOD is uniquely positioned to address fundamental questions by facilitating access to blood, urine and tissue samples which are intrinsically linked to details of the donor. When asked what he thought was the biggest hurdle facing sample accessibility, he highlighted the importance of effective communication between all parties concerning consent and regulation at the start of the retrieval process. “As we leverage new techniques” he said, “we need to consider how we communicate this [information] to a lay audience”.

Bill has many more strings to his bow, which I was delighted to discuss with him. Originally hailing from the United States, Bill recalls his aptitude for maths at an early age, entering maths competitions when at school. He later undertook an undergraduate course in engineering at Ivy League University, Cornell, which also included core biology modules in addition to maths and engineering. These early studies underpinned his combined interest in medicine and engineering; after all, an engineer is adept at problem-solving, and throughout his postgraduate and doctoral training in Minneapolis in biomedical engineering, it became evident to him that the fundamentals of engineering could be applied to help solve problems in the clinical sphere. His interest was piqued by organ donation and transplantation research where there were, and still are, a number of issues to tackle, all with the common goal of helping clinicians and improving transplant outcomes for patients.

The NHS relies on companies making reasonably priced and accessible devices to help healthcare professionals deliver expert care to their patients. Bill highlighted the problem that many products are not affordable and are manufactured in the United States with the US reimbursement model, which differs completely from that of the UK and Europe. New devices developed on the back of high-quality research must serve real-world needs as well as make a profit for investors. Sounds like a tall order, right?

With this in mind, Bill took his years of research and learning a whole new vocabulary to approach and pitch to investors, sought to develop a device that could address key issues raised by the transplant community. At present, the demand for organ transplants far exceeds the supply, and current preservation systems rely on static cold storage which cannot be relied upon to keep the donated organ in optimal condition for more than a few hours. Methods that can sustain optimal conditions for prolonged periods of time are too large, complex and expensive. Bill, in collaboration with clinical engineers, software developers and investors, have developed the ScubaTx device designed to be fit for the real-world transplant environment and automate as much of the process as possible, while providing feedback on key events for the surgical team who can focus their attention on the transplant procedure rather than setting up a machine. Funds have been raised through Innovate UK and currently a number of prototypes are going to stakeholders across the world, with the hope that one day in the near future the device will be suitable for commercialisation. 

Over the years, Bill has also successfully acquired financial backing for several start-ups and research projects. When asked what advice he would give to early career researchers and future entrepreneurs looking to write their own grant proposals, he emphasised the need to just put yourself out there. “You miss out on 100% of opportunities you don’t try for, [and] it takes 100 times of repeating the same task to get good at something” he said. Essentially, persistence and resilience are key. Bill also advised to “not limit yourself to one funder” and take time to understand what motivates the funder, as they will each want something different. He continues by describing the continual evolution of a grant proposal, adapting to the feedback received and the importance of finding the right investors and stakeholders who share your vision.

Bill can often be found in front of an audience of another kind as he leads the MRes Transplantation course as a Senior Lecturer and Associate Professor. He says it is a very rewarding experience as he gets the opportunity to inform, inspire and foster greater progress and interest in the field in the next generation of nurses, healthcare professionals and researchers, all of whom form the backbone of the NHS. For Bill personally, teaching also gives him the chance to re-connect with his specialist field, to see the bigger picture and highlight problems that face the current generation.

When asked what piece of advice he would give to his students and mentees, he highlighted the importance of forming a narrative, regardless of whether you are creating a poster, presentation or producing written work like a grant proposal or manuscript, “if you do not tell a story, then you are simply stringing together a series of facts on the screen or on paper, expecting others to read the situation exactly as you do”.

When Bill is not teaching, presenting or working in the lab, he enjoys hikes in the countryside with his dogs and fishing, where he can embrace the tranquillity and explore the natural beauty of Northumberland.

Dr Bill Scott was interviewed by Hannah McGivern

Spotlight on a QUOD Colleague – Maggie Stevens

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by Susan Patchett

For this edition of the QUOD Newsletter I was delighted to be able to catch up with Maggie Stevens, ODT Specialist Nurse for Research at NHS Blood and Transplant.  Maggie is responsible for the operational and service delivery for the great number of research studies that NHS Blood and Transplant operate and support alongside QUOD.

Hers is a varied role and involves setting up Specialist Nurse training, carrying out risk assessments for new studies, and helping teams draw up action plans and standard operating procedures (SOPS) ensuring that they comply with their ethics approval, regulatory requirements, and are fit for purpose for Specialist Nurses in Organ Donation (SNODs) to follow safely and effectively.

When I asked Maggie if she could describe a typical day she told me that there was no such thing.  One day she can be going through a risk assessment with the ODT Research Team and Quality Assurance for a large clinical trial and identifying potential operational, regulatory and safety risks.  Other days she will be auditing consent records to be sure all has been carried out to the letter.  She meets regularly with research leads in all the regions, ensuring they are up to date with studies that are being set up and also cascading training that they will undertake with their teams. 

Problem solving is a large part of her role and can range from SNODs raising issues if they aren’t comfortable with a particular process, to a shortage of boxes. 

Maggie works very closely with QUOD and helps us iron out issues that may arise in terms of sample collection, logistics, and other operational problems.  She forms the crucial link between QUOD and the SNODs.  After QUOD’s activity was paused during the first wave of COVID-19, she helped us with the mammoth task of restarting operations, updating SNOD training and finding ways around getting QUOD boxes delivered when so many personnel were working remotely between on-call shifts.

The elements of her job that she likes the most are the people and the research and innovation – ‘There is always wonderful new research going on such as the SIGNET trial and I find contributing to this work is really satisfying.’  She also said that her job is made very special by her colleagues, Hannah Tolley (OTDT Research Project Manager) and Emma Lawson (OTDT Innovation and Research Lead)). They work closely as a team linking in with other stakeholders to ensure that ODT research is facilitated safely and effectively. They also sit together alongside QUOD’s National Management Team.

I asked her if nursing was the career she had envisaged.  She laughed and said when she decided on nursing she was actually working at an agricultural college in Chelmsford, driving tractors and fruit picking.

Like all of us through the pandemic, Maggie has had to decamp her office to her home but she said she was one of many NHSBT staff who couldn’t bear sitting still when there were those working themselves to the bone on the front line so, she got herself deployed back to her original A&E department for six weeks.  She loved being back with her former colleagues.  I asked if she felt worried during that stint and she said ‘you just do what you have to do.’

Maggie Stevens is not all about work and loves an adventure in the great outdoors.  She has climbed Ben Nevis with colleagues for organ donation week and spent a couple of months travelling alone around Alaska where she saw whales and bears and met some wild and wonderful people that she will never forget.  She is also a fan of rock music and has tickets to see the Foo Fighters very soon!