Children awaiting liver and heart transplants cannot be guaranteed transport to hospital within the required time frame, according to a confidential document seen by RTÉ’s This Week.
In a report to the board of Our Lady’s Children’s Hospital in Crumlin (OLCHC), presented on 25 January, the hospital’s chief executive described the transport services as "unsustainable at this time".
The report says that the situation, which is due to staffing difficulties with pilots and air traffic controllers, "will remain unchanged until May 2017 at the earliest".
There are currently three children awaiting liver and heart transplants, which have been carried out in the UK since 1991.
Sinn Féin health spokesperson Louise O’Reilly, who has seen a copy of the report, described the situation as "particularly worrying for the gravely ill children and their families".
The report says the Health Service Executive’s National Aeromedical Command Centre (NACC), run by the National Ambulance Service, notified Crumlin hospital that staffing difficulties meant "transport of and transport timelines for Priority 1 children called for heart and liver transplants to the UK could not be guaranteed over the Christmas holiday period".
Contingency plans were put in place in December, according to the report, "following escalation to the Minister for Health’s office".
However, the report says the situation deteriorated to "unsustainable" levels in January: "On 3rd January, OLCHC was advised by NACC that the situation had worsened", the report says.
The chief executive’s report also says the four-hour time frame for transporting liver patients to the UK and six-hour time frame for cardiac patients was "unlikely to be achievable".
In a statement to This Week on Friday, the HSE said there were "no issues" with the transport service.
However, in a subsequent statement following further inquiries to the Department of Health by RTÉ, the HSE said it was "aware of pilot and air traffic personnel issues within the Irish Air Corps regarding the aeromedical services for paediatric organ transplant patients. Consequently, the availability of fixed wing aircraft for such transfers has recently been reduced".
OLCHC requested an urgent meeting with the Department of Health and the HSE’s Director of Organ Donation and Transplant for Ireland, which was held on 16 January, the report says.
Following the meeting, the Department of Health committed to continually raise the issue with the Department of Defence.
The health department today said Minister for Health Simon Harris and Minister of State with Special Responsibility for Defence Paul Kehoe are "acutely aware that immediate solutions are required".
It said the ministers are engaging on this issue and will meet again next week.
Mr Harris said. "I recognise the Department of Defence are working hard and look forward to progress and further engagement."
The Department of Defence said the Air Corp has a number of personnel vacancies across a number of functions due to some very experienced personnel, including pilots, retiring.
It noted: "The Air Corp continues to provide an inter-hospital air ambulance service, albeit a reduced one due to these shortages."
The department added that as well as pursuing steps to address the shortage, "the Defence Organisation has kept the Department of Health and the HSE fully informed of the situation in the Air Corps so that they can ensure the arrangements they have for the transplant transport service are as robust as possible".
The OLCHC Chief Executive report also says that the HSE was to contact the Health Information and Quality Authority following the mid-January meeting.
However, in answers to inquiries by This Week, HIQA had not been notified of any such difficulties by close of business on Friday.
Ms O’Reilly said the failure to contact HIQA pointed to a "disturbing lack of urgency" in the HSE’s handling of the matter.
"I would have thought HIQA would have been contacted immediately," the Dublin Fingal TD said.
A HSE spokesman told RTÉ that the families affected had been informed of the situation before Christmas and had been briefed by OLCHC ever since.
Liver transplants for children have been carried out at centres in the UK since the 1990s due to the low volume of operations in Ireland and the resulting difficulties in retaining the required doctors.
National Ambulance Service National Director Damien McCallion told This Week that while nine patients were transferred safely last year in the time frames, "there is an element of risk in this in every case".
He said that the Ambulance Service tries to ensure that they "minimise any risk, during this period when the Aer Corps are getting back up to their complement".
Following the 2011 case of Maedhbh McGiven, a 14-year-old liver transplant patient who missed a transplant due to transport difficulties, a 2012 HIQA report recommended setting up the NACC under HSE control.
According to the HIQA report on the McGiven case in 2012, increasing numbers of UK transplants are from "non heartbeat" donors, which require patients to be in the UK within a tight four-hour time frame from the time the organ becomes available.
The HIQA report says that failure to meet transplant timelines could result in offers of organs no longer being made to patients deemed to be too far from the hospital.
The HSE statement says it has "engaged with the Irish Coast Guard and private air ambulance providers in an effort to ensure that contingency arrangements are in place. These services will be utilised when needed and as available".