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Scandiatransplant UK Transplant AdB, France Swiss Transplant Lusotransplante ONT, Spain

Eurotransplant: An example of success for cross-border cooperation Bruno Meiser Eurotransplant International Foundation, Leiden, Netherlands Dept. of Cardiac Surgery University of Munich/Grosshadern Medical Center. 12 European Organ Exchange Organisations. Eurotransplant Balttransplant

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Scandiatransplant UK Transplant AdB, France Swiss Transplant Lusotransplante ONT, Spain

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  1. Eurotransplant:An example of success forcross-border cooperationBruno MeiserEurotransplant International Foundation,Leiden, NetherlandsDept. of Cardiac SurgeryUniversity of Munich/Grosshadern Medical Center

  2. 12 European Organ Exchange Organisations Eurotransplant Balttransplant Poltransplant Czechtransplant Hungarotransplant CNT, Italy HNTO, Greece Scandiatransplant UK Transplant AdB, France Swiss Transplant Lusotransplante ONT, Spain

  3. OEOs, by number of deceased donor transplants in 2003 5966

  4. Eurotransplant:An example of success for cross-border cooperation • History • Mission and goals • Organisational structure • Donation and waiting lists • ET allocation system - advantages of the international cooperation • Improved matching with better outcome • High urgency (HU) allocation • Help for special patient groups • Prevention of loss of donor organs

  5. 1967 A proposal for international cooperation in organ transplantation (based on HLA matching): EUROTRANSPLANT INTERNATIONAL FOUNDATION Prof. Dr. J.J. van Rood

  6. 2007 ET/Ministers conference: Affirmation of the ET mission

  7. Eurotransplant:An example of success for cross-border cooperation • History • Mission and goals • Organisational structure • Donation and waiting lists • ET allocation system - advantages of the international cooperation • Improved matching with better outcome • High urgency (HU) allocation • Help for special patient groups • Prevention of loss of donor organs

  8. Eurotransplant mission/goals • International non-profit organization, coordinating national allocation and international exchange of scarce organs

  9. Eurotransplant mission/goals • International non-profit organization, coordinating national allocation and international exchange of scarce organs • Aim is to encourage organ transplantation, to increase organ availability and use and to improve transplantation outcome by:

  10. Eurotransplant mission/goals • International non-profit organization, coordinating national allocation and international exchange of scarce organs • Aim is to encourage organ transplantation, to increase organ availability and use and to improve transplantation outcome by: • Providing a transparent and objective selection system based on medical criteria Recipient Information Donor Information Computer Best Match

  11. Eurotransplant mission/goals • International non-profit organization, coordinating national allocation and international exchange of scarce organs • Aim is to encourage organ transplantation, to increase organ availability and use and to improve transplantation outcome by: • Providing a transparent and objective selection system based on medical criteria • Assessing factors influencing transplant outcome and subsequently improving transplantation results based on scientific research

  12. Eurotransplant mission/goals • International non-profit organization, coordinating national allocation and international exchange of scarce organs • Aim is to encourage organ transplantation, to increase organ availability and use and to improve transplantation outcome by: • Providing a transparent and objective selection system based on medical criteria • Assessing factors influencing transplant outcome and subsequently improving transplantation results based on scientific research • Promoting and supporting transplantation in an extended European Community

  13. Visit of the European Commissionar for Health & Consumer Protection,Androulla Vassiliou in September 2008

  14. Zagreb 26.05.2006 International Eurotransplant Foundation: 125 millionen inhabitants in 7 states

  15. Eurotransplant:An example of success for cross-border cooperation • History • Mission and goals • Organisational structure • Donation and waiting lists • ET allocation system - advantages of the international cooperation • Improved matching with better outcome • High urgency (HU) allocation • Help for special patient groups • Prevention of loss of donor organs

  16. ET Transplantion-Programs (n=216) Leiden 69 41 38 25 4 39

  17. ELIAC ETKAC EPAC Board Ethics Com. ET Board + Advisory Committees ETHAC Comp. Serv. Work. Group Organ Procurement Com. Tissue Typing Adv. Com. Financial Com.

  18. Eurotransplant:An example of success for cross-border cooperation • History • Mission and goals • Organisational structure • Donation and waiting lists • ET allocation system - advantages of the international cooperation • Improved matching with better outcome • High urgency (HU) allocation • Help for special patient groups • Prevention of loss of donor organs

  19. The question of allocation equity is caused by the discrepancy between Donor Shortage Donor Shortage Donor Shortage Donor Shortage Donor Shortage

  20. …and growing active waiting lists in ET(per organ as of December 31st / each year)

  21. Post-mortem donation per million populationET 1992 - 2005

  22. Organ donation rates in Europe 0 17.2 19.9 26.9 14.5 19.2 21 18.7 13.2 13.2 14.1 15.7 15.6 27.2 21.1 2.1 25.3 21.6 10.7 15 11.4 23.9 13.1 34.3 1.2 21 5.8 Organ donors p.m.p. 2007 8.5

  23. Organ donation rates in ET 15,7 15.2 27.2 21.6 11.4 13.1 Organ donors p.m.p. 2007

  24. Organ donation rates in ET 15.2 15,7 12.3 14.4 27.2 24.9 21.6 20.2 11.4 17.8 13.1 17.9 Organ donors p.m.p. 2008 vs. 2007

  25. Deaths on waiting lists – European Union 2007 Total in the EU 4,317 persons (12 persons/day)

  26. Eurotransplant:An example of success for cross-border cooperation • History • Mission and goals • Organisational structure • Donation and waiting lists • ET allocation system - advantages of the international cooperation • Improved matching with better outcome • High urgency (HU) allocation • Help for special patient groups • Prevention of loss of donor organs

  27. 1386 1358 63 Austria Belgium 95 245 16 493 36 303 16 460 12 101 8668 103 102 Germany Slovenia 10 256 49 57 283 45 44 12 1919 Organexchnge in the ET-areaKidney transplantation 2000-2004 The Netherlands

  28. Eurotransplant:An example of success for cross-border cooperation • History • Mission and goals • Organisational structure • Donation and waiting lists • ET allocation system - advantages of the international cooperation • Improved matching with better outcome • High urgency (HU) allocation • Help for special patient groups • Prevention of loss of donor organs

  29. Kidney graft survival and HLA-ABDR mismatchesAdult first cadaver kidney-only transplants % 83% P=0.0001 71% Post-transplant time (m)

  30. HLA-matching in kidney transplantationET 2000-2004, non-ESP patients No. of mismatches No. of transplantations Percentage 2176 21,6 % 0 1 832 8,3 % 2 2679 26,6 % 3 3043 30,2% 4 1055 10,5 % 5 244 2,4 % 6 44 0,4% total 10073 100%

  31. Eurotransplant:An example of success for cross-border cooperation • History • Mission and goals • Organisational structure • Donation and waiting lists • ET allocation system - advantages of the international cooperation • Improved matching with better outcome • High urgency (HU) allocation • Help for special patient groups • Prevention of loss of donor organs

  32. HU transplantion liverWaiting time [n=1254] Children (<16 a) Adults (16+ a) n=201 (16%) n=1053 (84%) Median waiting time: 2 d (both groups)

  33. Eurotransplant:An example of success for cross-border cooperation • History • Mission and goals • Organisational structure • Donation and waiting lists • ET allocation system - advantages of the international cooperation • Improved matching with better outcome • High urgency (HU) allocation • Help for special patient groups • Prevention of loss of donor organs

  34. Mean waiting time kidney-transplantationImpact of the AM-program on highly-immunized patients, Eurotransplant 2006 n=26 n=47 n=3137

  35. International organ exchange in kidney transplantationImpact for selected patient groupsEurotransplant 01.01.2002 -31.12.2006

  36. Eurotransplant:An example of success for cross-border cooperation • History • Mission and goals • Organisational structure • Donation and waiting lists • ET allocation system - advantages of the international cooperation • Improved matching with better outcome • High urgency (HU) allocation • Help for special patient groups • Prevention of loss of donor organs

  37. Development of donation numbers for different donor age groupsReported kidney donors, Eurotransplant, 2000-2006 Donor age groups Number of donors (in relation to 2000)

  38. Turn-down of kidneys accord. to donor age: Eurotransplant vs. U.S.A. Cecka, et al. Transplantation 2006; 81: 966-70

  39. National organ import and export for different blood groups and countries 19,7% 41,2% 22,1% 36,7% 34,5% 73,9% 29,5% 73,5% 10,7% 14,4% 10,7% 18,4% 18,3% 28,9% 18,8% 38,5% 55,1% 100% 53,4% 100% Export Import A AB A AB Austria Belgium Germany Netherlands Slovenia

  40. 19,7% 41,2% 22,1% 36,7% 34,5% 73,9% 29,5% 73,5% 10,7% 14,4% 10,7% 18,4% 18,3% 28,9% 18,8% 38,5% 55,1% 100% 53,4% 100% National organ import and export for different blood groups and countries Export Import A AB A AB Austria Belgium Germany Netherlands Slovenia

  41. Summary • The donation rates in many European / some ET countries are still unsatisfactory; there is an increasing gap between donation rate and demand for transplantation • ET has successfully served more than 130.000 pts. by allocating 82.000 kidney-, 24.000 liver-, 15.000 heart-, 5.000 pancreas-, and 4.500 lung grafts through a transparent, quality and safety oriented allocation system • The collaboration within Eurotransplant offers additional benefits to participating centers and countries, e.g. trough improved patient oriented allocation, help for high urgency patient and for special patient group as well as avoidance of donor organ loss

  42. Outlook Eurotransplant Goals Promotion and support of Tx in an extended European Community • Stepwise approach to incorporate new members within the framework of a preliminary cooperation agreement in order to provide immediate support with regard to urgent pts., highly sensitized pts., children • Ultimate goal is a full membership within an acceptable timeframe •  Increase of the donor pool for all patients to improve outcome

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