The University of Southampton

Author: Timothy Wilson

A Joint Effort: NHS or Private – What’s the Right Option?

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Audio transcript:

The lecture series by Prof Dickinson on prosthetic joints prompted my thoughts on this topic with my tennis interest in Andy Murray and how it has affected close family friends.

The comeback of Murray following his hip resurfacing was astounding. Watching him win the European Open tournament in Belgium post-surgery demonstrated his determination and ability to compete at the highest level.

Andy Murray
An image of Andy Murray playing at the 2012 US Open. Available at https://commons.wikimedia.org/wiki/File:Andy_Murray_(US_Open_2012).jpeg (Accessed: 14/03/2025). By Francisco Diez, licensed under the Creative Commons Attribution 2.0 Generic license from Wikimedia Commons.

Murray’s hip resurfacing was done privately and quickly. I will share two stories from close family friends who have had very different experiences on knee replacements.

What is a knee replacement?

This topic is explained here. The summary is that knee replacements are used to treat pain and stiffness in the joint, usually caused by osteoarthritis. The process involves making an incision in the knee with metal and plastic replacement parts fitted as seen in the image below.

Total knee replacement image
An image of the components for a total knee replacement. Available at https://commons.wikimedia.org/wiki/File:Knee_Replacement.png (Accessed: 14/02/2025). By BruceBlaus, licensed under the Creative Commons Attribution-Share Alike 4.0 International license from Wikimedia Commons.

How successful are knee replacements?

A 2020 NHS report found that from over 80,000 patients, 75% responded that they felt much better following the operation with 64% being very satisfied with the results. The success of this treatment is why I feel access to them is so important, but the question of how to make it fair is challenging.

Wait times

The NHS has a very open website called My Planned Care. Taking the University Hospital Southampton statistics accessed on 21/03/2025, in the orthopaedic department the average wait time for treatment was 21 weeks. This led me to read a journal article “Who should have priority for a knee joint replacement?”. The degree of suffering, payment of National Insurance and caring for dependants are reported as the most important factors.

My friends

Ms D went down the private route for her knee replacement and had the operation within three weeks. Before this time, she had put on weight and was withdrawn socially. After the operation, Ms D’s mobility improved, and she resumed frequent international travels.

Ms C suffers from severe knee pain such that she rarely travels far on foot, something that has dampened her usually bubbly spirits. Ms C is opposed to private treatment. She also has a close friend who had a private knee replacement that was infected. Ms C is on an NHS waiting list for knee replacements and is hoping to have the operation in the next few months.

My dilemma

Both people have very different outlooks. My main concern is regarding quality of life. Ms D has now sadly passed away, but she lived ten years with her knee replacement. Ms C is in her late seventies and suffers. I tried to put it to Ms C’s husband in a recent phone call about “Why don’t you consider the private option?”, but it was quickly shot down. If it could be afforded, then the quality of life improvement would be massive, surely it would be worth the money?

Concluding thoughts

Having been a medical student for a couple of years before switching university courses, I have seen first-hand how the NHS system is struggling. I often have a pessimistic view on its survivability in its current form and I see private healthcare as a necessary evil.

Knowing that both suffered greatly, with Ms D having a huge quality of life improvement, makes me uncomfortable with the fact that this could’ve been avoided in Ms C’s case. I find myself feeling regret that Ms C hasn’t put her morals aside for the benefit of her physical and mental wellbeing.

The video below summarises my debate

A Heart Alternative – How Far Can We Go?

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Blog audio transcript:

Following the anatomy lab visit and lectures on stem cells, tissue engineering and prosthetics, it made me think about how far we can go towards developing an organ from a non-human origin. The heart stood out as one that could be in the realms of possibility compared to some of the more complex organs.

A labelled Diagram of the Internal Anatomy of the Heart
A Labelled Diagram of the Internal Anatomy of the Heart. Available at https://commons.wikimedia.org/wiki/File:2008_Internal_Anatomy_of_the_HeartN.jpg (Accessed: 25/02/2025). By OpenStax College, licensed under the Creative Commons Attribution 3.0 Unported license from Wikimedia Commons.

Genetically modified pig heart transplants have been carried out, with the first transplant performed in 2022 on a 57-year-old individual with end stage heart failure. This operation, formally called xenotransplantation, worked well for seven weeks, however the patient passed with heart failure after this time. It was found that the heart was vulnerable to rejection, it also contained traces of a virus that infects pigs.

A BBC Video Reporting on the First Patient to Receive a Pig Heart Transplant (Accessed: 23/02/2025). Captions are available on this video.

There is a very good reflective article linked here which talks about where to go after this xenotransplantation was carried out. Feel free to have a look if you are interested in reading more.

This transplant brings up ethical points to consider along with scientific challenges:

  • To what extent is it right to sacrifice animals for the benefit of humankind? Applying ethical concepts, most people would say more good is done by saving a human life than by sacrificing an animal such as a pig. Furthermore, if a pig could be genetically modified to become more humanised in the future, then perhaps more than one human life could be saved for each pig. Provided that the pig is well cared for during its lifetime, then this action of using its tissue would overall be deemed as “good” and the “right” action.
  • Scientific problems can happen during any transplantation. Specifically for pig heart xenotransplantation, immediate and acute rejection of the tissue can be an issue. Thrombosis, blood clots, can also occur due to a haematological incompatibility.

This video summarises the scientific and ethical implications of xenotransplantation:

An Interview Discussing the Scientific and Ethical Challenges Around Xenotransplantation (Accessed: 23/02/2025). Captions are available on this video.

A recent BBC article published in January 2025 highlighted work done in Germany where stem cells were used to develop patches of heart muscle cells which were then grafted onto damaged tissue. This could help patients with heart failure, giving encouraging results in trials.

A Screenshot of a BBC Article Titled “Scientists trial patch to mend failing hearts”
A Screenshot of a BBC Article Titled “Scientists trial patch to mend failing hearts”. Available to read at https://www.bbc.co.uk/news/articles/cgkjnl0dve8o (Accessed: 24/02/2025).

From a societal perspective, most of these developments on repairing heart tissue are novel. A high element of risk is not always worth it; however, it might be for those who have little or no alternative.

It is not uncommon to regularly come across news stories regarding the organ shortage. The UK organ donation law changed in May 2020 to an opt-out system meaning that by default adults are considered as potential donors.

In my view the moral status of a human life outweighs the sacrifice of an animal such as a pig. Scientific advance in this area should be encouraged within the framework of ethical boundaries. I cannot find a meaningful downside to pursue alternative methods of sourcing valuable organs.

Tim Wilson | UOSM2031 Intro Blog

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Hi! I’m Tim, a third-year natural sciences student. I’m looking forward to UOSM2031 and in particular learning about stem cells are prostheses.

Here is some example text.

Below is an example image with the Creative Commons Attribution.

A World War I prosthetic leg
A World War I prosthetic leg. Available at: https://commons.wikimedia.org/wiki/File:WWI_prosthetic_leg_(23656603546).jpg (Accessed: 31/01/2025). By Thom Quine, licensed under the Creative Commons Attribution 2.0 Generic license from Wikimedia Commons.

Here is an interesting TED Talk video on YouTube summarising stem cells. Captions are available alongside the video.