johannesburg region allocation of deceased donor kidneys 2011
Post on 11-Jan-2016
26 Views
Preview:
DESCRIPTION
TRANSCRIPT
Johannesburg Region Allocation of Deceased Donor Kidneys 2011.
Controversies Meeting 7-8 May 2011
Prof R.S.Britz and Nephrology Panel
Kim Crymble Transplant Coordinator.
In the beginning..prior to 2004Kidneys were allocated in a 50 / 50 split between
the state and the private sector to patients on the waiting lists.
The allocation was on Hla matches and negative cross match.
High PRA’s viewed as a reason not to allocate an organ even with a negative cross match a decision made by SANBS not the attending Nephrologists.
Regional Demographics In Johannesburg we have 3 Health Care
Providers where Renal Transplant are performedCMJAH as the State Sector facility who provides
Renal Transplantation for all State listed Patients Johannesburg and surrounding areas but also from Klerksdorp and Polokwane.
Netcare ( Milpark and Garden City Clinic) and Wits Donald Gordon Medical Centre who provide Transplant Care for the Privately funded Patients.
Health for all and access to CareIt was always viewed that the State Sector
Patient should always have equal access to Health Care as Organs Donated are from the community and should be for the benefit to all within the community.
So despite where donors are identified and harvested we had an allocation of one kidney to state and one kidney to the private list.
Private Vs Public Sector Harvested donors Johannesburg Region.
5 6
24
6
25
11
18
24
28
17
21
30
0
5
10
15
20
25
30
35
2004 2005 2006 2007 2008 2009 2010
Public
Private
Total Number of Donors Johannesburg 2010: 35 Donors
16
24
26
32
25
23
26
35
0
5
10
15
20
25
30
35
40
2004 2005 2006 2007 2008 2009 2009 2010
The current Allocation. The Allocation has evolved in the last few
years.
Based on an evaluation of all the currently used allocation systems worldwide and adapted for our Region.
Any decision related to the current system has been debated and accepted by all members of the Academic Renal Panel in Johannesburg.
Deceased Donor Kidney Allocation
The allocation system is Point based
Mostly a Time based system
Excel spread sheet run after defining system
Scrapped 50:50 system in 2010
Now everyone on one allocation list State and Private
Kidneys allocated to individuals not centres
State organ still largely sponsored by private
How does the Point System work. 1 year = 1 pointMinimal (No) HLA weighting2nd and subsequent transplants
penalized by 3 pointsPaeds get preference (extra points)Only 6 high PRA patients X matched
at any timeTop 30 patients cross matched
Age matched kidney allocationNon-Expanded criteria Kidneys Kidneys from Donors under the age of 55.
Expanded Criteria Kidneys (ECK)
Kidneys from Donors over the age of 55 or 2 of the following if the death has been due to a CVA, history of Hypertension Serum Creat levels are over 150.
Allocated to > 40 yr old recipients only>55 yr old patients only eligible for ECK
Minimum Donor Data required for allocation of Kidneys. Non Expanded Criteria Donor Age
Expanded Criteria DonorAge / Date of BirthSerum CreatMedical History
Recipient DataIndependent Data capturerEnters data and administers the listFor all Kidney Transplant recipients in
Johannesburg
Information required:JHB Renal Panel formPatients HLA and current PRA’sPhysician assessment form which claims
fitness for Transplant.
Allocation Spreadsheet:Donor ID :
GROUP O
EXPANDED CRITERIA DONOR KIDNEY?
N
MUST SORT THIS
COLUMN ASCENDING!
Date:
09/05/2011 KIDNEY
LISTING ORDER
X Match +Ve?
PT NO. .Name PRA Urgent? HospPoints
1 Y 71 KHES**, SIP** 85
JHB PAEDS 10
ADDITIONAL URGENT PATIENT
2 N 73 KH**, X** 83 CHB 10
NAMEPT NO. PRA
X Match +Ve?
Urgent?
B Group Patient?
3 Y 49 GEL***, T**
100 KLERK 9
Nil Nil Nil Nil Y
4 N 46 F**, H** 98 WITS 8
Allocated 1st, UNLESS there is an urgent listed in top 10
Thank You
Queries to Professor R.S.Britz
011 356 6488.
top related