Maisie Almond

Parliamentary Under-Secretary of State    
for Health Innovation and Safety 

 39 Victoria Street 
 London 
 SW1H 0EU 

5 May 2026 

HM Assistant Coroner A Farrow 
Coroner’s Court 
1 Mount Tabor Street 
Stockport 
SK1 3AG 

Dear Mr Farrow, 

Thank you for the Regulation 28 report of 27/02/2026 sent to the Secretary of State 
of the Department of Health and Social Care about the death of Maisie Kate Almond. 
I am replying as the Minister with responsibility for organ transplantation. 

Firstly, I would like to say how saddened I was to read of the circumstances of 
Maisie Kate Almond’s death and I offer my sincere condolences to their family and 
loved ones. The circumstances your report describes are concerning and I am 
grateful to you for bringing these matters to my attention. 

The report raises concerns over: 

1.  A national shortage of donor livers generally and particularly for children in the 

“super urgent” category. 

2.  Clinical guidance not to use donation after circulatory death (DCD) livers. 
3.  A reduction of around one third in donor liver availability has extended waiting 

times from within 48 hours to up to a week. 

In preparing this response, my officials have made enquiries with NHS Blood and 
Transplant (NHSBT) to ensure we adequately address your concerns. I note NHSBT 
will also be issuing a direct response.  

I recognise and share your concerns about the current constraints on donor liver 
availability, particularly for children requiring super urgent transplantation. Liver 
transplantation depends on the availability of suitably matched deceased donor 
organs, and factors such as size, blood group and clinical urgency can mean that a 
compatible organ is not always found in time. 

While it is important to acknowledge that not every death can be prevented, the 
issues you highlight underline the need for continued scrutiny of transplant 
pathways, organ utilisation, and the systems that support timely access to suitable 

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 organs for those most in need, alongside continued research into treatments for liver 
failure that may help stabilise patients and bridge the gap while a suitable donor 
organ is identified. In this response, I will outline actions underway to improve donor 
organ availability and access to transplantation. 

National shortage of donor liver availability and access to transplantation 

There is a national shortage of donor livers, which continues to place pressure on 
access to transplantation and extend waiting times, particularly for patients requiring 
urgent care. This shortage is driven by a combination of factors, including declines in 
donor numbers and donation consent rates, as well as changes in donor 
demographics. Regrettably, in this case, a suitable donor liver was not made 
available in time for Maisie Kate Almond. 

The Department recognises that delays in access to suitable donor livers, particularly 
for children requiring super urgent transplantation, present a significant clinical risk. 
The actions set out below are intended to address the risks you have identified and 
to reduce the likelihood of similar circumstances arising in future. 

The Department is working with NHSBT and wider system partners to improve 
access to transplantation and reduce waiting times by increasing the overall supply 
of donor organs and maximising the use of those available. This includes work to: 

a.  Increase the overall supply of donor organs: While the availability of 
donated organs is variable, increasing registration on the NHS Organ 
Donor Register and improving family consent rates may increase 
transplant opportunities for people on the waiting list. In cases such as 
Maisie Kate Almond’s, where altruistic living donation was not possible 
and an urgent deceased donor liver was required, a higher number of 
successful donations may have increased the likelihood of a suitable 
organ becoming available. 

Organ Donation Joint Working Group (ODJWG) 

•  The Department and NHSBT jointly established the Organ Donation 
Joint Working Group (ODJWG) to identify actions to maximise the 
number of lives saved through deceased organ donation, build on 
positive developments, such as legislative change, and learn from 
less successful approaches.  

•  The Group brought together national and international experts in 

organ donation, including donor families and service providers, and 
set out ten actions to improve deceased organ donation in the UK. 
These actions, set out in the Group’s final report, A bolder, braver 
approach for organ donation in the UK, published in January 2026, 
are now being taken forward by NHSBT and system partners. 

Education and public awareness 

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 •  NHSBT undertakes a range of activity to raise awareness of organ 
donation, particularly in communities where donation rates are 
lower. This includes targeted work during Organ Donation Week, 
partnerships with trusted organisations such as the National BAME 
Transplant Alliance, and a Community Grant Programme which 
support community and faith‑based organisations to drive 
awareness and understanding of organ donation. 

• 

In addition, the Department for Education revised the Relationships, 
Sex and Health Education guidance, to make education on organ 
donation a mandatory part of the secondary school curriculum from 
September 2026, helping to improve understanding and enable 
young people to make informed decisions about donation. 

b.  Maximise the use of available organs: Alongside efforts to increase 
organ donation, the Department has prioritised work to improve organ 
utilisation. Even where organs are donated, barriers in assessment, 
preservation or system capacity can mean that opportunities for 
transplantation are missed. Improving organ utilisation is therefore critical 
to reducing delays and ensuring that patients waiting for urgent transplants 
have the best possible chance of receiving a suitable organ in time. 

Implementation Steering Group for Organ Utilisation 

•  The Department established the Implementation Steering Group for 
Organ Utilisation (ISOU), which concluded in December 2025, to 
deliver the recommendations of the Organ Utilisation Group and 
maximise opportunities for transplantation. The Group, which 
concluded in December 2025, focused on improving collaboration 
across transplant services and supporting fair and equitable access 
to transplantation.  

•  The ISOU has supported wider system improvements, including 

strengthening clinical leadership, standardising pathways, 
promoting collaboration between transplant centres, and enabling 
innovation in how organs are assessed and allocated. Clinical 
Leads for Organ Utilisation have been established in all transplant 
centres to drive local improvement and shared learning.  

•  As the ISOU concludes the Department is committed to maintaining 
momentum to continue to improve organ utilisation and achieving 
better outcomes for patients and families across the UK. 

Assessment and Recovery Centres 

•  Through the ISOU, the Department provided funding to support the 
development and mobilisation of Assessment and Recovery Centre 
(ARC) pilot schemes. ARCs are specialist centres designed to 
assess, repair and optimise donor organs prior to transplantation, 

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 with the aim of improving organ utilisation, reducing unwarranted 
variation and supporting more transplants to occur.  

•  The ARC programme is being developed as a national multi‑organ 
approach, with early pilots for lungs, liver and kidneys launching in 
phases during 2026. ARCs have the potential to deliver significant 
numbers of additional organs available for transplantation each 
year, thereby helping to improve access to transplantation and 
reduce waiting times. 

DCD Livers in Paediatric liver transplantation 

The Department recognises the concerns raised in your report about the impact that 
limitations on suitable donor liver availability can have on children requiring super 
urgent transplantation. Decisions regarding the clinical suitability of organs for 
transplantation, including the use of DCD livers, are made by clinicians and are 
based on the best available evidence. NHSBT has advised that, while DCD livers are 
an important source of organs when transplanted as whole livers, they are not 
routinely split, which is often required for paediatric cases. This is because splitting 
DCD livers is associated with a higher risk of graft failure and poorer outcomes for 
recipients.  

This guidance is kept under regular review, and NHSBT, together with the wider 
transplant community, continue to monitor emerging evidence and technological 
developments. When robust evidence demonstrates that changes in practice can be 
made safely and improve outcomes for patients, clinical guidance can and will be 
updated. 

Research into the Prevention and Treatment of Liver Failure 

Alongside action to increase the supply of donated organs and maximise the use of 
those available, the Department also supports research into preventing and treating 
liver failure, including approaches that can stabilise patients while they await 
transplantation. This includes investment of over £1.7 billion each year on research 
through the National Institute for Health and Care Research (NIHR), which funds 
clinical, public health and social care research, works in partnership with the NHS, 
universities, local government, other research funders, patients and the public, and 
supports global health research. This investment supports the NIHR BioResource 
which includes a cohort of participants with Non-Alcoholic Fatty Liver Disease 
(NAFLD) who have consented to be recalled for research. Researchers can apply for 
access to participant’s data or recall participants from the NAFLD BioResource to 
support studies aimed at improving our understanding of liver disease or developing 
new treatments to improve patient care. Further information about NIHIR Awards for 
research in Liver Failure is available on the NIHR’s Funding and Awards website. 

I recognise the profound impact Maisie Kate Almond’s death has had on her family 
and loved ones, and I am grateful to you for raising these concerns. The Department 
is continuing to work closely with NHSBT, NHS England and the transplant and 

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 research communities to increase donor organ availability and maximise organ 
utilisation and support access to transplantation.  

I hope this response is helpful. Thank you for bringing these concerns to my 
attention. 

Yours sincerely, 

Parliamentary Under-Secretary of State 
for Health Innovation and Safety 

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Patient Safety Team  
Newcastle Blood Centre 
Holland Drive Barrack Road 
Newcastle upon Tyne  
NE2 4NQ 

Private & Confidential  

HM Assistant Coroner A Farrow  
Coroner’s Court 
1 Mount Tabor Street 
Stockport 
SK1 3AG 

1st April 2026 

Dear HM, Assistant Coroner A Farrow  

Re: Regulation 28 Report, 27th February 2026 

On behalf of NHS Blood and Transplant (NHSBT), we would first like to take this opportunity 
to offer our condolences to the family and friends of Maisie Kate Almond, following her death 
at the Leeds General Infirmary, Leeds on 2nd October 2024. 

We note the matters of concern; 

1.  Evidence  from  a  consultant  paediatric  hepatologist  that  there  is  a  national 
shortage of donor livers generally and particularly for children in the “super urgent” 
category. 

2.  The clinical guidance not to utilise cardiac death donor livers in such cases due 
to the poor historical outcomes has narrowed the pool of suitable donor livers to 
those arising from brain deaths. Altruistic living liver donations are generally not 
available for super urgent cases. 

3.  The  number  of  donor  livers  has  reduced  by  a  third  and  the  effect  is  that, 
historically, a donor liver could be expected to be made available within 48 hours, 
the wait has now extended to up to a week. That delay gives rise to a clear risk 
that lives will be lost due to the unavailability of suitable donor organs. 

We will respond to the matters of concern as noted above as 1,2 & 3. 

1.  National  shortage of  donor  livers  generally and  particularly for  children  in  the 

“super urgent” category 

The UK, like many other countries, is facing ongoing challenges with both donor numbers and 
consent rates. Although organ donation activity had been steadily recovering in the years 
following the pandemic, this progress has been offset by a continued decline in consent rates. 
The most recent UK data for 2024–2025 shows that the pool of potential donors is now 18% 
smaller than before the pandemic, and family consent rates have fallen from 68% to 59%. 

As a result, April of last year saw the highest number of people on the UK transplant waiting list 
ever recorded. While the number of patients waiting is now slowly beginning to decrease, the 
reality remains that there are still not enough donor livers available to meet clinical need. 

The  three  paediatric  liver  transplant  units  in  the  UK  regularly  split  suitable  adult  livers  to 
transplant children. In the UK, split liver transplantation (usually for one child and one adult) 
is always prioritised from, high-quality, donors after neurological death testing (DBD) who are 

NHS Blood and Transplant is a Special Health Authority within the National Health Service. 

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 aged <45 years and weight < 90 kg. These livers are always offered to centres for splitting to 
maximise organ usage for the paediatric population.  

The donor profile in the UK has changed significantly, with donors now generally being older—
the current average age is 53. In addition, donor BMI has increased. These shifts, combined with 
a smaller and less healthy donor pool, reduced family consent rates, and circumstances of death 
that limit donation, have collectively decreased the number of livers suitable for splitting. 

2.  DCD Livers in Paediatric liver transplantation 

We have also seen a shift in donor type across the UK, with an increasing proportion of donors 
after circulatory death (DCD) compared with donors after brain death (DBD) over the past two 
years. This trend has not been observed previously, and it appears to be continuing. Notably, 
similar patterns are being reported in other countries. 

As a result of this shift, fewer livers now meet the criteria for splitting, as DCD livers are not 
routinely split due to the increased risk of graft failure. While all donor types carry some degree of 
risk, splitting a DCD liver presents particular challenges. Nevertheless, DCD donors remain an 
important source of organs across the UK. Advances in emerging technologies may in time 
support the safe splitting of DCD livers, but at present, national guidance continues to 
recommend splitting only DBD livers. 

Historically splitting a DCD liver is associated with high rates of biliary complications and small for 
size ischaemia seen across the world. Isolated case reports, conference reports and centre 
experience from Spain and Italy suggest feasibility of splitting DCD livers from young donors 
(<40) with short functional warm ischaemia and prolonged stable Normothermic Regional 
Perfusion (NRP), with good lactate clearance. This is not evidenced across the world as it is not 
routinely done, but when it is facilitated, it is done through in-situ splitting. DCD-NRP splitting is 
currently regarded as experimental and any such activity in the UK will sit under a service 
evaluation needing innovation governance and possible research ethics. As NRP is rolled out 
across all retrieval teams DCD-NRP splitting can be evaluated 

3.  Reduction in donor livers and extended waiting time 

Points 1 and 2 above explain the reasons for the current shortage of donor organs.  

It is impossible to predict the availability of a liver for the super urgent category both adult 
and children. For children we are usually waiting for a suitable liver to enable liver splitting 
or a liver to become available from a child or young adult suitably sized match to enable 
transplantation. Unfortunately, the ongoing shortage of donor organs has further extended 
waiting times, and in this case, a suitable liver did not become available on time. 

Action being taken 
NHSBT is working to ensure that we address the challenges in the donation pathway. 
Some of the various initiatives underway include but are not limited to: 

•  Marketing,  Communication,  and  Societal  Action:  Continue  with  strategies  to  raise 

awareness and improve public support for organ donation.  

•  Clinical  Practice:  Enhancements  in  clinical  protocol  and  practice  to  widen the pool 
of potential donors  being  reviewed.  Alongside  this,  work  to  look  at  neurological  death 
testing  improving  access  to, and  consistency  of  testing  has  commenced.  This  work  will 
endeavour to increase the number of DBD donors in the UK, with the ultimate of ensuring 
more  organs  can  be  available  for  liver  splitting  and  cardiothoracic  transplantation. 
Streamlining the family approach to enhance consent rates being reviewed. 

NHS Blood and Transplant is a Special Health Authority within the National Health Service. 

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 • 
• 

•  Coroners  working  group:  continue  to  collaborate  with  HM  Coroners,  Police,  Forensic 
Pathologists and Medical Examiners to ensure we can maximise the number of potential 
organ donors, where possible. This PFD is scheduled for discussion at the next meeting. 
Increased use of novel technologies for DCD donation. 
Introduction  of  Assessment  and  Recovery  Centres  (ARCs)  for  organ  donation.  ARCs 
improve organ donation by utilising specialized machine perfusion to assess, repair, and 
recondition  "marginal"  organs  previously  deemed  unsuitable  for  transplant.  These 
centres aim to increase the number of viable organs, reduce transplant waiting lists, and 
allow for safer, high-quality organ transplantation. 

We are very sorry that the call for transplant did not come for this child. 

We have shared the PFD with the wider donation community to reinforce the importance of 
considering organ donation in all appropriate clinical circumstances. 

Please do not hesitate to contact us should you have any further questions about our service.  

Your sincerely 

Director of Organ and Tissue Donation and Transplantation 

Medical Director 
Organ and Tissue Donation and Transplantation 

NHS Blood and Transplant is a Special Health Authority within the National Health Service. 

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