Change of heart
By completing the first non-beating heart transplant in Europe, consultant surgeon Stephen Large could radically reduce the time for those on the donor waiting list. Sarah Holmes discovers the part Freemasons have played in this medical breakthrough
A heart attack in 2008 was the beginning of Huseyin Ulucan’s slow decline into heart failure. By 2014, his condition had deteriorated so severely that he could barely walk. Placed on the transplant list, he joined a long queue of urgent cases. Of the 250 people a year in need of heart transplants in the UK, fewer than half will find a viable organ in time.
While the chance of Ulucan finding a new heart seemed low, everything changed in March 2015 when he was put forward for a bold new transplantation procedure that would reduce the wait for a donor heart from three years to just four months. Traditional transplants only use hearts from donors who have been declared brain-stem dead but still have blood pumping around their bodies. This new procedure used a non-beating heart that had been reanimated in the donor’s body after death.
Using a groundbreaking technique, surgeons kept the heart beating in the donor body for 50 minutes to test its function, before transporting it on a three-hour journey to Papworth Hospital, Cambridgeshire, for transplant into Ulucan. The procedure was the first of its kind to be performed in Europe, and looks set to revolutionise the field by opening up a new supply of donor hearts previously thought unusable.
‘This procedure could increase heart transplantation by 25 per cent in the UK,’ says Stephen Large, the consultant cardiothoracic surgeon (opposite) who oversaw the operation. For three years, he and a research team at Papworth have worked tirelessly to fine-tune the techniques needed to restart and restore a non-beating heart. ‘It means that instead of accepting one in five hearts offered, surgeons will be able to accept two or maybe even three.’
The operation’s success has transformed attitudes towards donation after cardiac death, with Papworth now receiving at least one referral per week. It’s a remarkable feat given the longstanding belief that non-beating hearts become irreparably damaged during the process of death. This breakthrough proves that by re-establishing a fresh supply of blood within 30 minutes of death, the heart can restore its energy supplies enough to start pumping efficiently again.
A £200,000 donation from The Freemasons’ Grand Charity and the Masonic Samaritan Fund allowed Large to establish the project in February 2013, paying for costly organ-care technology as well as the employment of Simon Messer, the cardiothoracic transplant registrar who helped to develop the technique for restarting the heart.
‘It’s difficult to determine whether an organ will function properly once it’s been transplanted. With a heart, it’s even more challenging because it has to be beating,’ says surgeon Charles Akle, a member of the Non-Masonic Grants Committee of The Freemasons’ Grand Charity. ‘The fresher the organ, the better the chance of a successful transplant – there have always been problems with maintaining the quality of a heart, especially one that’s already stopped beating, until it reaches the recipient.’
‘It’s difficult to determine whether an organ will function properly once transplanted. With a heart, it’s even more challenging, because it has to be beating.’ Charles Akle
Keep the rhythm
To this end, the team at Papworth used a revolutionary new technology, the TransMedics Organ Care System, to give the donor heart a steady supply of warm blood. Known as normothermic perfusion, this technique keeps the heart beating as it would inside the body after it’s been removed, so it doesn’t suffer further damage during the journey to the recipient. It’s an essential support system for non-beating hearts, which have already suffered a prolonged lack of blood supply and wouldn’t survive the traditional method of preserving donor organs on ice.
‘TransMedics really takes the heat out of the situation,’ says Large. ‘It allows us to travel greater distances with a “live” heart, and gives us the time to properly assess whether a donor organ is being matched with the right recipient.’
In Ulucan’s operation, the decision to continue with the transplant fell to Steven Tsui, the clinical director of transplantation at Papworth. Watching him mull over his thoughts while the donor heart pumped away on the TransMedics was, Large admits, the most nerve-shredding moment of the procedure.
‘After years of research, that was the final hurdle,’ he recalls. ‘I said to him, “You need to wrestle with your demons here, but this I’m sure is a great heart.” ’ Within minutes, it was being stitched into its recipient and just four weeks later, Ulucan was back at home enjoying his new lease of life. ‘That’s an outstanding recovery by any standard. It must have been a phenomenal heart,’ says Large.
Opening up the donor pool
Without the support of the Freemasons, Large’s research could never have translated into the successful clinical programme it is today. ‘One of the greatest challenges of research is realising the funds to do it,’ says Large. ‘Competition is fierce, and translational programmes like this struggle to attract funding from the Medical Research Council.’
As both a researcher and fund-giver, Charles also understands the challenge. ‘We get pulled in so many different directions at the Grand Charity. It’s impossible to prioritise one research project over another. They are all worthy,’ he says. ‘But we do tend towards applications with a more methodological process, something that’s likely to have a good result that can be developed to benefit other conditions.’
Large’s funding application ticked all the boxes.
‘It provided an immediate and flexible solution for heart transplantation that opened up the donor pool,’ says Charles. ‘It also laid the groundwork for further research into preserving donor organs for as long as possible.’
For Large, the research is only just beginning. ‘Snipping out dodgy organs and stitching in new ones is a replacement therapy. It’s up to the next generation to find out why organs deteriorate and how we can regenerate them organically. I just wish I had another lifetime to see it, because that will be such fun.’
‘A great challenge of research is realising the funds to do it. Competition is fierce, and programmes like this struggle to attract funding from the Medical Research Council.’ Stephen Large
Developed in the US, the TransMedics Organ Care System pumps warm, oxygenated, nutrient-rich blood through a heart, allowing it to keep beating from the moment it’s removed from the donor until it’s implanted in the recipient. A transparent chamber fixed to the top of the machine allows surgeons to watch the attached organ pump blood as it would in a body. Dubbed the ‘heart-in-a-box’, it has also been used to transplant livers and lungs.
Making new connections
Scientists hope the knowledge gained from vital research will offer new clues for the treatment of Alzheimer’s
Every four seconds, there is a new case of dementia in the world. The condition is caused when the brain is damaged by diseases such as Alzheimer’s, which affects half a million people in the UK. The symptoms of Alzheimer’s vary but typically include memory loss, confusion, disorientation, and mood and behavioural problems.
As Alzheimer’s progresses it can alter a person’s life entirely, robbing them of their memories and independence, causing them to require constant support. There are currently no treatments that slow or halt progression of the disease – something that it is hoped can be changed through research.
The Grand Charity and the MSF recently joined forces to provide a £175,000 donation to Alzheimer’s Research UK, to help fund efforts to identify new targets for treating the disease. This research is taking place at the University of Cambridge and seeks to understand the chain of events occurring at the onset of the disease. Over the past 30 years, the central masonic charities have donated £855,000 towards dementia research, while also caring for people living with the disease.
One of the difficulties researchers face is finding participants for studies; at the same time, many members of the public are looking for studies to take part in, but don’t know where to find them. A national service, Join Dementia Research, tackles the problem by connecting participants with researchers, helping to recruit the right volunteers for the right study. The service is open to all – those with dementia, their carers and anyone who wants to improve the lives of people living with the condition.
If you are interested in helping to find a cure for dementia, the National Institute for Health Research is currently inviting people to take part in clinical research studies. To find out more, please visit www.joindementiaresearch.nihr.ac.uk
Emergency help at Sussex hospice
In the early hours of 11 July, a fire took place at St Michael’s Hospice in St Leonards-on-Sea, East Sussex.
Twenty three patients with progressive life-limiting illnesses were evacuated, along with one family member and nine members of staff. In the days following the incident, three patients died, two of whom had been treated for smoke inhalation.
The Grand Charity responded with an emergency grant of £5,000 to help with immediate recovery efforts. Since 1987, St Michael’s has been part of the Grand Charity Hospice Scheme and has received more than £84,000. The Province of Sussex also donated £5,000 via the Sussex Masonic Charities.
Perdita Chamberlain, St Michael’s head of fundraising, said, ‘We would like to thank the Sussex Freemasons and the Grand Charity for their continued support and their incredibly generous donation.’ Hospice CEO Celia Pyke-Lees praised the nursing team, calling them ‘true heroines’ on the night of the fire.
Consultant physician James Dennison added, ‘I was very pleased to hear that both the Province of Sussex and the Grand Charity had quickly responded. It is wonderful to see Freemasonry in action like this.’
Howzat for a charity fundraiser?
The Province of West Kent organised the ideal opportunity to celebrate raising £3.25 million for the MSF at its Howzat! Festival day. The event featured a charity cricket match as well as arena entertainment and food and drink, and attracted Freemasons, their families and members of the local community to The Warren in Bromley.
Children were entertained by fairground stalls, bungee runs and a climbing wall. For others, there were beer and Pimm’s tents; performances by the Scout and Guide Marching Band; and a duck herder, who held particular interest.
The Province’s donation cheque was proudly displayed at its stand, which stood alongside stalls for the Masonic Fishing Charity and Hi Kent, a local charity for the deaf and hard of hearing. MSF Chief Executive Richard Douglas said, ‘It was a fantastic day and gave me the opportunity to meet the Freemasons of West Kent and thank them personally for their incredibly generous donations to the Masonic Samaritan Fund.’
2020 vision in Herefordshire
The Province of Herefordshire has officially launched its 2020 Festival Appeal by presenting an initial donation of £45,000 to the Masonic Samaritan Fund. Herefordshire Provincial Grand Master the Rev David Bowen opened the appeal at the Provincial Grand Lodge in June.
MSF President Willie Shackell received the donation from the Province and offered his sincere thanks for such a generous contribution towards the Fund’s work. He said, ‘Your generosity will make a tremendous difference to so many people waiting to receive the treatment and care they need to live healthy and independent lives.’
Process of evolution
The rules that define Freemasonry are not set in stone, but rather adapt with changing times, as John Hamill, Director of Special Projects, explains
Ask a group of members why we do a certain thing or organise in a particular way and the response will be, ‘Because we’ve always done it that way.’ But as anyone who’s read a little of our history knows, that statement is rarely borne out by the facts.
Today, with the exception of five London lodges under the direct supervision of the Grand Master, all our lodges at home are grouped under the Metropolitan Grand Lodge of London or one of the 47 Provincial Grand Lodges. Each group is headed by a Metropolitan or Provincial Grand Master who is appointed, by patent, by the Grand Master as his personal representative within his defined area.
All lodges in the Metropolitan or Provincial Grand Master’s area come under their supervision and are required to hold a meeting of that Metropolitan or Provincial Grand Lodge at least once a year. They are also empowered to appoint Metropolitan or Provincial Grand Officers, promote existing officers and appoint brethren to past Metropolitan or Provincial rank.
So embedded is the system that it is natural to assume it has always existed, the more so as the office of Provincial Grand Master is one of the oldest in our constitution. The first was Francis Columbine, acknowledged by the Premier Grand Lodge as Provincial Grand Master for Cheshire in 1725.
Grand Masters under the premier Grand Lodge made many appointments from 1727 onwards but the appointment of a Provincial Grand Master in no way implied the existence of a Provincial Grand Lodge. Columbine was empowered to appoint ‘Grand Officers pro tem’ to assist him, particularly in constituting new lodges or carrying out public ceremonies. Once the event was over, those ‘Grand Officers’ reverted to their original masonic status.
The death or resignation of a Provincial Grand Master by no means guaranteed the appointment of a successor, unless the lodges in the Province petitioned the Grand Master for a replacement. In a number of cases an appointment was made for a county in which no lodges existed, presumably in the hope that the appointee would stimulate the formation of lodges. In other cases, it is known that the appointee had no connection with and never visited his charge!
The idea of holding an annual Provincial Grand Lodge seems to have been introduced by Thomas Dunckerley, who between 1767 and his death in 1795 was Provincial Grand Master for eight Provinces. He took his duties seriously, regularly visiting his charges to hold Provincial Grand Lodge meetings, stimulating the formation of new lodges and ensuring that his lodges made their annual returns to the Grand Lodge.
The idea of Provinces or Provincial Grand Masters was unknown under the Antients Grand Lodge at home but they did warrant Provincial Grand Lodges overseas. The warrant designated the first Provincial Grand Master but empowered the Province to elect his successors. It also gave them permission to constitute new lodges, which were to be reported to London to be issued with a Grand Lodge warrant. Because of the distances and precarious nature of travel at that time, many constituted lodges never made it onto the Antients Grand Lodge Register.
A foundation for today
Changes brought about by the Union of the two Grand Lodges in 1813 laid the basis of our present system. The appointment of Provincial Grand Masters remained the prerogative of the Grand Master but they were enabled to appoint Provincial Grand officers, who were given their own distinctive regalia and jewels. If a Provincial Grand Master died or resigned, the Province ceased to exist until a successor had been installed. The current system of the Deputy Provincial Grand Master being in charge was introduced as late as the 1880s.
Although the 1815 Constitutions required at least annual Provincial Grand Lodge meetings, it was not until the 1860s that the rule was fully complied with and Provinces began to send annual reports of their doings to the Grand Secretary. So rather than existing since time immemorial, our Metropolitan and Provincial system has gradually evolved and continues to evolve and adapt to the times we live in.
‘In a number of cases, an appointment was made for a county in which no lodges existed; in other cases, it is known that the appointee had no connection with and never visited his charge!’
To preserve captured moments in the history of Freemasonry, the Library and Museum is digitising masonic films to enable anyone to view them
The Library and Museum stores and cares for collections of older records on behalf of Grand Lodge and the masonic charities. Among these are films such as a 1929 newsreel of a ceremony marking the extension at Treloar Hospital in Hampshire, and a film made for the RMBI in 1978 entitled Life in Our Homes.
Former head of the East Anglian Film Archive David Cleveland was asked by the Library and Museum to undertake a survey of the film reels to identify duplicates, and to advise on methods of destruction for some of the duplicate material.
Current recommendations are for the transfer of reel film to digital media for long-term preservation. The process is costly but the Library and Museum has received support from London’s Screen Archives (LSA), which transferred 16 film titles to digital media at no charge, courtesy of the British Film Institute’s Unlocking Film Heritage Digitisation Fund. The digitisation was completed by Prime Focus in London’s Soho.
All 16 titles will be accessible with full descriptions at the LSA website. After copying, the reel films are kept in specialist storage at the London Metropolitan Archives. With half of the film titles in its collection now available online, the Library and Museum is working on ways to preserve the rest of its film collection.
Films can currently be viewed at the BFI Player portal: http://player.bfi.org.uk/search
Jubilee research votes counted
To celebrate 25 years of generous donations from the masonic community, the MSF is awarding £1 million in medical research grants across England and Wales. Freemasons were invited by the Fund to vote for a research study shortlisted for support in their region by the doctors, consultants and care experts of the MSF’s Board of Trustees.
MSF Grants Director and Deputy Chief Executive John McCrohan said, ‘Each grant we award brings us closer to finding treatments and cures for the illnesses and disabilities that affect masonic families as well as the wider community. Thank you to all those who voted, we value your opinion and appreciate your support.’
The voting period is now closed, and results will be revealed via the MSF website and e-newsletter in September.
New perspectives on training
A pioneering technique in the way carers are trained has been revealed to journalists during a special session at RMBI care home Prince Michael of Kent Court in Watford
On 18 June, journalists from BBC Breakfast, Reuters and Radio 4 joined care home manager Elizabeth Corbett and her team to take part in the RMBI’s innovative training programme, Experiential Learning. The initiative puts carers in the shoes of their residents, helping them to understand what it might be like to live in a care home.
During the session, journalists were given the opportunity to experience some of the daily challenges faced by some 400,000 older people who live in care homes across the UK. Scenarios included being pushed in a wheelchair while blindfolded, receiving supported feeding to eat a meal, being hoisted from a seated position and wearing a wet incontinence pad.
An individual approach
The RMBI has practiced ‘person-centred’ care in its homes for a number of years. Adopting a person-centred perspective is a way of providing tailored care and support based on the resident’s point of view – ‘standing in their place’ and appreciating how they might be feeling. This is a very different approach from treating everybody in the same way and makes the care that RMBI provides individual to each resident.
Louise Bateman, Director of HR at the RMBI, explained how the need for specific training in this area was identified: ‘In 2014 we reviewed our recruitment and induction programmes for new care staff. We wanted to ensure that we were recruiting individuals not solely upon their technical skills or abilities, but on the basis of their values and attitudes to care.’
Bateman said that the RMBI realised it was important for its carers to have an empathic approach and to be able to step into the shoes of residents under their care. ‘We talked to recently joined carers as well as managers to develop our thinking.
From this we redesigned the induction programme to include the Experiential Learning initiative so that we could improve the quality of our service and provide residents with a deeper level of person-centred care,’ she continued.
The initiative has been in place for all new care staff in RMBI care homes since October 2014 – from nurses and activity coordinators through to carers and shift leaders. Plans to expand the training are also well underway, with additional scenarios to be included, such as brushing someone’s teeth.
Senior Care Trainer Nina Stephens, who led the Experiential Learning session, said: ‘This new way of training carers has already improved the lives of the people in our homes. It allows RMBI care staff to have a greater insight into some of the challenges faced by our residents. We feel that experiential learning should be adopted by the whole care sector, as part of the drive to raise care standards to the highest level.’
Now Jake’s ready for his close-up
One trauma is more than enough for any child to deal with, but before Jake turned 16 he had experienced his parents’ divorce as well as his mother’s battles with breast cancer and redundancy. Causing stress and anxiety, these events also led to financial hardship for Jake and his mother.
As Jake grew older, he dreamed of pursuing a career in the performing arts. Realising it would be impossible for his mother to support his aspirations, Jake decided to learn a trade – but deep down he longed to work in front of or behind the camera.
Jake’s grandfather Mike, a Freemason, had always encouraged his grandson to pursue his dreams. When Mike was diagnosed with terminal cancer in 2012, he encouraged Jake to reach out to the RMTGB for support. Jake was accepted as a beneficiary, gained a place at his chosen university and was offered a room at the RMTGB’s student residence, Ruspini House.
‘Without the Trust, I would not have been able to follow my dream,’ said Jake, who plans to become a Freemason after he graduates so that he can help other children to succeed and give back to the masonic community.
Find out how the RMTGB supported Jake by watching the video at www.rmtgb.org/jake