Automating Organ Allocation at NHSBT
Key Points
- NHS Blood and Transplant (NHSBT) is a major NHS division supporting the UK’s free‑at‑point‑of‑use health system, which serves the entire nation with a £120 billion annual budget and 1.3 million staff.
- NHSBT’s three core responsibilities are: supplying safe blood to every English hospital (≈1.7 million donations yearly), providing specialized diagnostic and therapeutic testing (including immunology, tissue typing, and stem‑cell services with pioneering genetic sequencing), and managing organ donation and transplantation, facilitating about 4.5 k transplants per year.
- The organisation processes roughly 6 000 blood units daily, handles 11‑12 k tissue implants annually, and oversees half of the UK’s stem‑cell donations, making it a global leader in donor‑recipient matching.
- A critical challenge is the organ‑transplant waiting list of 6.5 k patients, resulting in an average of three deaths per day while waiting for a suitable organ.
- To tackle this, NHSBT is collaborating with surgeons and clinicians to automate and refine organ‑allocation processes, striving to balance equity, utility, and fairness in transplant distribution.
Sections
- NHS Blood & Transplant Automation Journey - A briefing outlines NHSBT’s massive scale, its three core functions, and how it is leveraging process automation to support the UK's free-at-point-of-use healthcare system.
- Complexity of Modern Liver Allocation - The speaker outlines how balancing utility and fairness amid numerous evolving clinical, donor, and geographic factors has made liver allocation increasingly intricate, exposing the shortcomings of outdated, poorly understood systems built fifteen years ago.
- From Whiteboard to Automated Workflow - The team replaced a risky manual whiteboard system for tracking urgent transplant patients with IBM’s Blueworks Live, Operational Decision Manager, and Business Process Manager to map, rule, and automate the process.
- Seamless Platform Integration for Transplant Workflow - The speaker explains how a unified, reusable platform—combining on‑premise and cloud capabilities with IBM’s support—lets their staff transition to a new application without changing their workflow, enabling end‑to‑end digitization of the organ allocation and transplant process.
- Technology Empowering Life‑Saving Mission - The speaker emphasizes that at NHS Blood and Transplant, advanced automation tools like IBM’s are leveraged not for novelty but to fulfill their core purpose of delivering hope and saving lives.
Full Transcript
# Automating Organ Allocation at NHSBT **Source:** [https://www.youtube.com/watch?v=v0vLiGGOl-c](https://www.youtube.com/watch?v=v0vLiGGOl-c) **Duration:** 00:13:45 ## Summary - NHS Blood and Transplant (NHSBT) is a major NHS division supporting the UK’s free‑at‑point‑of‑use health system, which serves the entire nation with a £120 billion annual budget and 1.3 million staff. - NHSBT’s three core responsibilities are: supplying safe blood to every English hospital (≈1.7 million donations yearly), providing specialized diagnostic and therapeutic testing (including immunology, tissue typing, and stem‑cell services with pioneering genetic sequencing), and managing organ donation and transplantation, facilitating about 4.5 k transplants per year. - The organisation processes roughly 6 000 blood units daily, handles 11‑12 k tissue implants annually, and oversees half of the UK’s stem‑cell donations, making it a global leader in donor‑recipient matching. - A critical challenge is the organ‑transplant waiting list of 6.5 k patients, resulting in an average of three deaths per day while waiting for a suitable organ. - To tackle this, NHSBT is collaborating with surgeons and clinicians to automate and refine organ‑allocation processes, striving to balance equity, utility, and fairness in transplant distribution. ## Sections - [00:00:00](https://www.youtube.com/watch?v=v0vLiGGOl-c&t=0s) **NHS Blood & Transplant Automation Journey** - A briefing outlines NHSBT’s massive scale, its three core functions, and how it is leveraging process automation to support the UK's free-at-point-of-use healthcare system. - [00:03:19](https://www.youtube.com/watch?v=v0vLiGGOl-c&t=199s) **Complexity of Modern Liver Allocation** - The speaker outlines how balancing utility and fairness amid numerous evolving clinical, donor, and geographic factors has made liver allocation increasingly intricate, exposing the shortcomings of outdated, poorly understood systems built fifteen years ago. - [00:06:31](https://www.youtube.com/watch?v=v0vLiGGOl-c&t=391s) **From Whiteboard to Automated Workflow** - The team replaced a risky manual whiteboard system for tracking urgent transplant patients with IBM’s Blueworks Live, Operational Decision Manager, and Business Process Manager to map, rule, and automate the process. - [00:09:56](https://www.youtube.com/watch?v=v0vLiGGOl-c&t=596s) **Seamless Platform Integration for Transplant Workflow** - The speaker explains how a unified, reusable platform—combining on‑premise and cloud capabilities with IBM’s support—lets their staff transition to a new application without changing their workflow, enabling end‑to‑end digitization of the organ allocation and transplant process. - [00:13:01](https://www.youtube.com/watch?v=v0vLiGGOl-c&t=781s) **Technology Empowering Life‑Saving Mission** - The speaker emphasizes that at NHS Blood and Transplant, advanced automation tools like IBM’s are leveraged not for novelty but to fulfill their core purpose of delivering hope and saving lives. ## Full Transcript
[Music]
And good afternoon everyone and it's a
real pleasure for me to be here and be
able to share with you a little bit of
our story as NHS blood and transplant
and our journey of process automation.
NHS blood and transplant is one of about
450 organizations uh together with 7 and
a half thousand family practices that
collectively make up the United Kingdom
National Health Service.
It's a service that provides health care
services to every resident of the United
Kingdom free at the point of use and
with an annual spend of about 120
billion pounds and with 1.3 million
employees.
The NHS is the fifth largest employer in
the world after the US Department of
Defense, the uh Chinese people
liberation people's liberation army,
Walmart and McDonald's. So it's a huge
operation to provide that healthcare
service.
NHSBT's role in that service really
falls into three areas. We are
responsible for providing a safe and
reliable supply of blood to every
hospital in England. working with just
under a million blood donors every year
uh to process about 1.7 million
donations or 6,000 units of blood a day
to service the needs of hospitals uh
throughout the UK
sorry throughout England. Um our
diagnostic and therapeutic services
function is an area where we carry out a
range of specialized testing for the NHS
specialized blood testing. We carry out
uh immunology testing uh tissue typing
and a range of services that the NHS
would not otherwise have.
And in that function, we also provide
about 11,000 or 12,000 uh tissue
implants every year.
And we manage about 50% of the UK stem
cell donations. And we were the first
blood service in the world to start
genetic sequencing of our stem cell
donors in order to enable better
matching of donors to recipient.
And then we have our organ donation and
transplantation function where we work
with families at what for them is an
incredibly tragic and difficult time to
have a conversation about whether or not
their loved one who has just died or is
dying would have wanted to be an organ
donor. and if they are to make
arrangements for their organs to be
retrieved and transplanted
enabling 4 and a half thousand
transplants to take place in the UK
every year
but the transplant waiting list is 6 and
a half thousand people
and therefore on average three people
die every day in the UK waiting for an
organ transplant and that's a problem
and that's the problem I want to talk to
you a little bit about this afternoon
and how We have attempted to address
that.
We attempt to address that by working
very closely with transplant surgeons
and with clinicians to improve the organ
allocation processes and to improve the
organ allocation schemes to balance the
sometimes competing priorities of
equity, the principle of equal access to
the transplant to a transplant
opportunity.
Utility, the idea that we will make
maximum use of the organs that are
available. and fairness, the idea that
if someone's been waiting for a long
time, they should probably have a degree
of priority on the waiting list.
But as we make changes to those
allocation schemes, we hit upon a
problem. And that problem is that
they're becoming increasingly complex.
What you're seeing on the screen are
just some of the factors that are taken
into consideration in our liver
allocation scheme as it is currently
being developed.
They take into account physical factors
about the donor and the potential
recipient. They take into account the uh
clinical situation of the donor and the
recipient and they take into account the
geography where each of them is based.
And those factors aren't static. They
change over time. And we learn more and
more over time about how we could
actually allocate more organs more
effectively in order to try and ensure
that everyone has the best chance
possible of receiving a life-saving
transplant.
In our existing systems however this
complexity was very hard to manage. Our
systems were developed largely about 15
years ago. They were built as most
applications were at that particular
point in time. And the reality is no one
really knows the intricacies of those
systems anymore. A lot of that knowledge
is gone.
That leads us to another problem. The
time when this is all happening and how
the decision process works.
Because organ donation almost inevitably
happens in the middle of the night very
often and it's a very time-sensitive
process.
We have people who have to make
decisions about who the recipient or the
potential recipient should be, which
order we should offer the organs out to
the different transplant centers in
order for them to make a decision about
which recipient should receive those
organs.
And they have to do that in the shortest
possible time because the longer they
take to get through the offering
process, the longer that family is
waiting to know what's going to happen
in terms of donation.
And that process is at least was at
least 96 steps long. And what you're
seeing on the screen are just some of
the workflow that used to apply to that
process. And every box on the screen
that is that is coded red or colored
red, sorry, is a step in that process.
That was a manual step that our highly
skilled officers in our duty office had
to work through for every single donor
that we had.
And the third problem that the observant
among you might have spotted in the last
two slides is across the bottom. The
time that it took to make changes to our
systems. Because of the nature of the
systems, because of the complexity of
the systems and the complexity of the
workflow,
it took us on average about 2 years to
implement a new organ allocation scheme.
That's two years when we could have had
a more effective scheme where we could
have saved and improved more lives.
So that's the problem
that we wanted to solve. It was a
problem that was exacerbated by the fact
that there were always exceptions.
And some of those exceptions we couldn't
even manage in our systems. So we had a
workaround and that workaround was a
whiteboard in the office where we put
the name or the details of every urgent
transplant patient on the waiting list.
These are the patients who if they
didn't receive a transplant most
probably would not live for very much
longer.
And every time one of these patients got
transplanted or every time one of these
patients sadly died, somebody in the
office had to go and wipe off that
particular line and retranscribe every
line below it upon the list so that we
always had an up-to-date list of of
urgent transplant patients.
This was not a process that we were very
happy with. It's not a process that we
felt was safe and it wasn't a process
that was enabling us to do our jobs as
effectively as we might.
That's the problem that we then came and
spoke to IBM about.
And in the course of those
conversations, we stumbled on three
products that collectively we thought
would help us to address those problems.
Blueworks live, the operational decision
manager and the business process
manager.
Blueworks live enables us to have a
conversation with the people who are
actually working in the office about the
processes that they are actually
following to map them out in a way that
they can understand and interpret them
and then to look to take that forward
into some sort of automation tool.
The operational decision manager has
enabled us to start to build flexible
rules, rules that we know we can change
quickly because we understand how the
rules are constructed within the context
of the decision manager product. And the
business process manager gives us the
supportive workflow that our staff need
to automate that process and enable them
to get on with the job of talking to the
transplant centers and engaging and
liazing with our staff in the uh
donation hospitals to make sure that the
families have the best possible
experience of donation uh when that is a
genuine possibility. And all of those
products we've chosen to implement using
the oncloud version. The reason for that
is quite straightforward. I do not want
to have a whole team of people worrying
about how many virtual machines we need
in order to operate a particular piece
of software. I do not want to have a
whole team of people spending all their
time worrying about how many uh or what
particular variety of infrastructure we
need to buy tomorrow. Our expertise,
what we know how to do is how to take
technology and apply it to what we do
best, saving and improving the lives of
others through better, more effective
organ allocation schemes.
So, this is what it starts to look like
now.
On October the 25th last year, we went
live with the first of our systems, our
heart allocation scheme,
and we allocated the first heart in the
world using a cloud-based system, the
tools that I've just talked about. We
started that process from scratch in
March of last year and we implemented it
in October. That two-year cycle was
reduced to just 6 months. And in that
process, we automated about 40 of the 96
steps that were previously involved in
the process. A significant reduction in
the number of manual steps that our
staff have to go through in that time
critical moment.
For me, the real beauty of it was that
we were able to do that by integrating
the ex the new product to work very
closely with our existing applications
so that our staff didn't have a
fundamentally different experience when
they move from an old application to a
new application. The two came together.
Sure, they got a much better look and
feel, but they didn't have to go hopping
between different applications to do
their work. They were able to you to to
do it all in one seamlessly integrated
environment, making use of our existing
on-remise capability and the cloud
capability in the cloud systems.
We used the platform because we wanted
repeatability and reusability.
Much of what we have developed for our
heart allocation schemes can be reused
in all of the other allocation schemes
that we're now on the process of
developing.
We wanted a platform because it allows
us to iterate and improve over time. We
know the platform will get better and we
don't have to do all of the work to make
the platform get better. We've got other
people, the good people in IBM who are
helping us with that and hopefully uh
improving the platform as we go.
And we were able therefore to map our
end-to-end user journey and to build it
all the way out as part of our process
of digitization. We have now digitized
everything from the point that our
specialist nurses approach the family in
the intensive care department right
through to the point that we offer the
organs for transplant to the transplant
centers. And we're not stopping there.
Later this year, we will implement a new
liver allocation scheme which we
anticipate will save 50 lives every year
because of the better allocation that we
are able to to implement. We will deploy
a digitized transplant waiting list to
enable the transplant centers to manage
their patients digitally uh and update
the information regularly so it is as
current as possible throughout the
process.
Going back to that three-fold piece
about what process automation means for
us, it is about that discovery piece.
It's about being able to work with our
users or our customers, understand what
they need, engage with them in the
process of of identifying what the
automation should look like
and engage them in the process of
building it.
We focus specifically in the automation
process on the points of pain. Whether
that's cost, whether that's risk,
whether that's delays,
the pain point gave us a really solid
business case in order to invest in this
technology and be able to do some
automation.
But beyond all that, we needed the
insights. We needed the insights that
building a new technology gave us, but
we also needed the insights that the
technology is starting to give us. And
as we move forward, we anticipate that
we will actually be able to learn from
the technology and improve the
allocation schemes further because we
won't simply be analyzing data in a
traditional statistical fashion. We'll
be able to analyze the data that is now
in our allocation schemes and improve
them in real time to save and improve
the lives of others.
Because that's what this is really all
about. This isn't about the technology.
It isn't about how wizzy and fancy it
all gets. It's about how we can use that
technology to contribute to our core
purpose and what we stand for as an
organization.
At NHS Blood and Transplant, we're proud
to say that we stand for hope. We stand
for life and we stand for enabling
people to do something extraordinary
every day to save and improve the lives
of others, to save and improve the lives
of little girls like this, Phoebe, who's
one of our blood recipients. and the
process automation that we're able to to
carry out working with the IBM tools is
about enabling us to do more of that and
enabling us to be more effective at what
we can do at what we can be as an
organization. Thank you very much.