arie oosterlee
TRANSCRIPT
Arie OosterleeArie Oosterlee
Dinner debateDinner debate
EUROPEAN PARLIAMENT EUROPEAN PARLIAMENT
Bruxelles, December 3th, 2008Bruxelles, December 3th, 2008
Coordination of European Coordination of European transplant systemstransplant systems
Leiden6666
3737
44
3939
2525
3838
Total population: 124,5 Mill.
ET Transplant ET Transplant ProgramsPrograms
Mission Mission StatementStatement
ET is a service organization for
transplant patients through the
collaborating the transplant
programmes within the organisation
Donation, waiting lists and Donation, waiting lists and transplantationtransplantation
Kidney waiting list and transplantsKidney waiting list and transplants Eurotransplant 1969 - 2007Eurotransplant 1969 - 2007
11308
3703
1032
Each day, Each day, 9 European citizens9 European citizens die whilst die whilst waiting for a suitable organ transplant*waiting for a suitable organ transplant*
*3.262 deaths on the waiting list in 2007, Council of Europe data 2008*3.262 deaths on the waiting list in 2007, Council of Europe data 2008
Grim facts…Grim facts…
Based on: Leo Roels, Donor Action
Allocation principlesAllocation principles
Organ Allocation PrinciplesOrgan Allocation Principles
• Equity: every patient the same chanceEquity: every patient the same chance
• Queuing: longest waiting firstQueuing: longest waiting first
• Need/urgency: sickest patient firstNeed/urgency: sickest patient first
• Utility: best post-Tx outcome firstUtility: best post-Tx outcome first
• Net benefit: balancing urgency and Net benefit: balancing urgency and
outcomeoutcome
Urgency Outcome
Kidney graft survival and HLA-ABDR mismatchesKidney graft survival and HLA-ABDR mismatches Adult first cadaver kidney-only transplantsAdult first cadaver kidney-only transplants
50
60
70
80
90
100
0 1 3 6 9 12 24 36
0 N=1009 1 N=408 2 N=1209 3 N=1316
4 N=464 5+6 N=75
Post-transplant time (m)
P=0.0001
%
83%
71%
No. of No. of MismatchesMismatches
No. of No. of transplantstransplants
percentagepercentage
00 21762176 21,6 %21,6 %
11 832832 8,3 %8,3 %
22 26792679 26,6 %26,6 %
33 30433043 30,2%30,2%
44 10551055 10,5 %10,5 %
55 244244 2,4 %2,4 %
66 4444 0,4%0,4%
totaltotal 1007310073 100%100%
HLA-matching in kidney transplantationHLA-matching in kidney transplantationET 2000-2004, non-ESP patientsET 2000-2004, non-ESP patients
Organ exchange in the ET areaOrgan exchange in the ET areaKidney transplantation 2000-2004Kidney transplantation 2000-2004
The Netherlands
Austria Belgium
Germany Slovenia8668
1358 1386
103
1919
245303
95
63
1616
10
12283256
102
101
4549
4457
36
12460
493
Directive & Action plan
• Quality:1.1. Reduce organ shortageReduce organ shortage
• Awareness in ICU’s & public Awareness in ICU’s & public • Exchange of Best practicesExchange of Best practices
2.2. Combat traffickingCombat trafficking
3.3. Improve transplant outcomeImprove transplant outcome• Registry Registry
• transplanted patients transplanted patients • living donorsliving donors
• OrganovigilanceOrganovigilance
Stakeholders stay alert!
1st reading should not result in:
• Increase Shortage:• Risk management: no elimination!
• Delay Process:• Accountability: no bureaucracy!
• Hinder Transport:• “Special” patients: no borders!
Thank you for your attention
Balancing urgency and outcomeBalancing urgency and outcome“Transplant window“-concept“Transplant window“-concept
-> Increasing organ failure ->
Mortality
Med. TherapyTransplantation
benefit
“too early”
“too late”
“Transplantation window”
Queuing: longest waiting firstQueuing: longest waiting firstEmergency departmentEmergency department
?
Organ allocation principlesOrgan allocation principles
• Equity: every patient the same chanceEquity: every patient the same chance• Sense of fairness or impartialitySense of fairness or impartiality
• Lack of bias or discriminationLack of bias or discrimination
• Queuing: longest waiting firstQueuing: longest waiting first
• Need/urgency: sickest patient firstNeed/urgency: sickest patient first
• Utility: best post-Tx outcome firstUtility: best post-Tx outcome first
• Net benefit: balancing urgency and Net benefit: balancing urgency and
outcomeoutcomeLotteryLottery
Equal/similar patientshave to be treated
equal/similar
• Equity: every patient the same chanceEquity: every patient the same chance
• Queuing: longest waiting firstQueuing: longest waiting first• Waiting time is easy to understandWaiting time is easy to understand• ““first come first served” is a fair way to do first come first served” is a fair way to do
thingsthings
• Need/urgency: sickest patient firstNeed/urgency: sickest patient first
• Utility: best post-Tx outcome firstUtility: best post-Tx outcome first
• Net benefit: balancing urgency and Net benefit: balancing urgency and outcomeoutcome
Organ Allocation PrinciplesOrgan Allocation Principles
ET organ allocation - renalET organ allocation - renal
Highly immunized - Acceptable Mismatch (AM) - Program
Zero Mismatch (“full house”)
ETKAS Point Score System (including HU)
A
Pediatric Donor (< 10 a) to Pediatric Recipient (< 6 a) when HLA-DR-identical
Eurotransplant Senior Program (ESP)
B/L D HR NL SLO
International organ exchange in kidney International organ exchange in kidney transplantationtransplantation
Impact on selected patient groupsImpact on selected patient groupsEurotransplant 01.01.2002 -31.12.2006 Eurotransplant 01.01.2002 -31.12.2006
0%
20%
40%
60%
80%
100%
Outside ET 0 1 0 0 44
Other ET country 121 1022 141 87 1422
Recipient country 60 1420 336 271 9106
Highly immunized
000- HLA MM
PaediatricHigh
UrgencyOther