eurotransplant: an example of success for cross-border cooperation bruno meiser eurotransplant...

Eurotransplant:Eurotransplant:An example of success forAn example of success forcross-border cooperationcross-border cooperation

Bruno MeiserBruno MeiserEurotransplant International Foundation,Eurotransplant International Foundation,

Leiden, NetherlandsLeiden, NetherlandsDept. of Cardiac SurgeryDept. of Cardiac Surgery

University of Munich/Grosshadern Medical CenterUniversity of Munich/Grosshadern Medical Center

ScandiatransplantScandiatransplant

UK TransplantUK Transplant

AdB, FranceAdB, France

Swiss TransplantSwiss Transplant

LusotransplanteLusotransplante

ONT, SpainONT, Spain

EurotransplantEurotransplant

BalttransplantBalttransplant

PoltransplantPoltransplant

CzechtransplantCzechtransplant

HungarotransplantHungarotransplant

CNT, ItalyCNT, Italy

HNTO, GreeceHNTO, Greece

12 European Organ Exchange 12 European Organ Exchange OrganisationsOrganisations

163

339

456

503

517

1162

1290

2428

2817

3288

3540

0 1000 2000 3000 4000 5000 6000

HNOT, Greece

Sw iss Transplant

Hungarotransplant

Czech Transplant

Lusotransplante

Scandiatransplant

Poltransplant

UK Transplant

CNT Italy

EfG, France

ONT, Spain

Eurotransplant

kidneys

livers

hearts

lungs

pancreas

small bowel

5966

OEOs, by number of deceased OEOs, by number of deceased donor transplants in 2003donor transplants in 2003

• 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

Eurotransplant:Eurotransplant:An example of success for cross-border An example of success for cross-border

cooperationcooperation

19671967

A proposal for A proposal for international cooperation international cooperation in organ transplantation in organ transplantation (based on HLA matching): (based on HLA matching):

EUROTRANSPLANT EUROTRANSPLANT INTERNATIONAL INTERNATIONAL FOUNDATIONFOUNDATION

Prof. Dr. J.J. van RoodProf. Dr. J.J. van Rood

20072007ET/Ministers conference: ET/Ministers conference:

Affirmation of the ET missionAffirmation of the ET mission

• History











Eurotransplant Eurotransplant mission/goalsmission/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





- Assessing factors influencing transplant outcome and subsequently improving transplantation results based on scientific research





- Assessing factors influencing transplant outcome and subsequently improving transplantation results based on scientific research

- Promoting and supporting transplantation in an

extended European Community

Visit of the European Visit of the European Commissionar for Commissionar for Health & Consumer Health & Consumer

Protection,Protection, Androulla Vassiliou Androulla Vassiliou in September 2008in September 2008

International Eurotransplant International Eurotransplant Foundation: 125 millionen Foundation: 125 millionen

inhabitants in 7 statesinhabitants in 7 states

Zagreb 26.05.2006Zagreb 26.05.2006

• History











Leiden

6969

3838

44

4141

2525

3939

ET Transplantion-Programs ET Transplantion-Programs (n=216)(n=216)

BoardEthics Com.

Organ Procurement

Com.

ETKAC

ELIAC ETHACEPAC

ET Board + Advisory ET Board + Advisory CommitteesCommittees

Financial Com.

Tissue Typing

Adv. Com.

Comp. Serv. Work. Group

• History











The question of allocation equity is caused by the discrepancy

between

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

0

2000

4000

6000

8000

10000

12000

14000

0

400

800

1200

1600

2000

2400Kidney

Heart

Heart+Lung

Lung

Liver

(Ki)Pancreas

Post-mortem donation per million Post-mortem donation per million populationpopulation

ET 1992 - 2005ET 1992 - 2005

0

5

10

15

20

25

30

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Austria Belgium/Lux. Germany

Netherlands Slovenia ET-average

34.3

13.2

25.3

2123.9

10.7

2119.2

18.713.2

19.9

14.5

17.2

27.2

15.7

1511.4

15.621.1

21.62.1

1.213.1

14.1

8.5

0

26.9

5.8

Organ donation rates in Organ donation rates in EuropeEurope

Organ donors p.m.p. 2007

27.2

15,7

11.4

15.2

21.6

13.1

Organ donation rates in Organ donation rates in ETET

Organ donors p.m.p. 2007

Organ donors p.m.p. Organ donors p.m.p. 2008 2008 vs. 2007vs. 2007

27.2

15,7

11.4

15.2

21.6

13.117.9

17.8

20.2

14.412.3

24.9

Organ donation rates in Organ donation rates in ETET

662 429

1,3201,906

0

500

1000

1500

2000

2500

Kidney Liver Heart Lung

Dea

ths

in t

he

WL

(a

bso

lute

nu

mb

ers)

0.0

1.0

2.0

3.0

4.0

5.0

Dea

ths

in t

he

wai

tin

g li

st

(pm

p)

Absolute numbers Rate (pmp)

Total in the EUTotal in the EU

4,317 persons (12 persons/day)4,317 persons (12 persons/day)

Total in the EUTotal in the EU

4,317 persons (12 persons/day)4,317 persons (12 persons/day)

Deaths on waiting lists – European Union 2007Deaths on waiting lists – European Union 2007

• History











Organexchnge in the ET-areaOrganexchnge in the ET-areaKidney transplantation 2000-Kidney transplantation 2000-

20042004

The Netherlands

Germany Slovenia8668

1358 1386

103

1919

Austria Belgium95

63

245303

1616

10

12283256

102

101

4549

4457

36

12460

493

• History











Kidney graft survival and HLA-ABDR Kidney graft survival and HLA-ABDR mismatchesmismatches

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%

100%100%1007310073totaltotal

0,4%0,4%444466

2,4 %2,4 %24424455

10,5 %10,5 %1055105544

30,2%30,2%3043304333

26,6 %26,6 %2679267922

83283211

2176217600

PercentagePercentageNo. of No. of transplantationstransplantations

No. of No. of mismatchesmismatches

HLA-matching in kidney HLA-matching in kidney transplantationtransplantation

ET 2000-2004, non-ESP patientsET 2000-2004, non-ESP patients

21,6 %21,6 %

8,3 %8,3 %

• History











819

39

191

4

0-2 d 3-4 d

5-8 d 9-16 d

128

4

3

27

39

0-2 d 3-4 d 5-8 d

9-16 d 16+ d

n=201 (16%) n=1053 (84%)

HU transplantion liverHU transplantion liverWaiting time [n=1254]Waiting time [n=1254]

Children (<16 a) Adults (16+ a)

Median waiting time: 2 d (both groups)

• History











Mean waiting time kidney-Mean waiting time kidney-transplantationtransplantation

Impact of the AM-program on highly-immunized Impact of the AM-program on highly-immunized patients, Eurotransplant 2006patients, Eurotransplant 2006

Highly immunized- not AM-Program

AM-Program Other0

365

730

1095

1460

1825Days

n=26 n=3137n=47

International organ exchange International organ exchange in in

kidney transplantationkidney transplantationImpact for selected patient groupsImpact for selected patient groups

Eurotransplant 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

• History











Development of donation numbers Development of donation numbers for different donor age groups for different donor age groups

Reported kidney donors, Eurotransplant, 2000-2006Reported kidney donors, Eurotransplant, 2000-2006

0

50

100

150

200

250

2000 2001 2002 2003 2004 2005 2006

Year

0-15

16-54

55-64

65 and up

Donor ageDonor agegroupsgroups

Nu

mb

er

of d

on

ors

Nu

mb

er

of d

on

ors

(in

re

latio

n to

20

00)

(in

re

latio

n to

20

00)

Cecka, et al. Transplantation 2006; 81: 966-70

Turn-down of kidneys accord. to donor age:Turn-down of kidneys accord. to donor age:Eurotransplant vs. U.S.A.Eurotransplant vs. U.S.A.

National organ import and export for National organ import and export for different blood groups and countriesdifferent blood groups and countries

SloveniaSlovenia

NetherlandsNetherlands

GermanyGermany

BelgiumBelgium

100%100%

38,5%38,5%

18,4%18,4%

73,5%73,5%

36,7%36,7%

53,4%53,4%

18,8%18,8%

10,7%10,7%

29,5%29,5%

22,1%22,1%

100%100%

28,9%28,9%

14,4%14,4%

73,9%73,9%

41,2%41,2%

55,1%55,1%

18,3%18,3%

10,7%10,7%

34,5%34,5%

19,7%19,7%AustriaAustria

ABABAAABABAA

ImportImportExportExport

SloveniaSlovenia

NetherlandsNetherlands

GermanyGermany

BelgiumBelgium

100%100%

38,5%38,5%

18,4%18,4%

73,5%73,5%

36,7%36,7%

53,4%53,4%

18,8%18,8%

10,7%10,7%

29,5%29,5%

22,1%22,1%

100%100%

28,9%28,9%

14,4%14,4%

73,9%73,9%

41,2%41,2%

55,1%55,1%

18,3%18,3%

10,7%10,7%

34,5%34,5%

19,7%19,7%AustriaAustria

ABABAAABABAA

ImportImportExportExport

National organ import and export for National organ import and export for different blood groups and countriesdifferent blood groups and countries

SummarySummary• The donation rates in many European / some ET The donation rates in many European / some ET

countries are still unsatisfactory; there is an countries are still unsatisfactory; there is an increasing gap between donation rate and demand increasing gap between donation rate and demand for transplantationfor transplantation

• ET has successfully served more than 130.000 pts. ET has successfully served more than 130.000 pts. by allocating 82.000 kidney-, 24.000 liver-, 15.000 by allocating 82.000 kidney-, 24.000 liver-, 15.000 heart-, 5.000 pancreas-, and 4.500 lung grafts heart-, 5.000 pancreas-, and 4.500 lung grafts through a transparent, quality and safety oriented through a transparent, quality and safety oriented allocation systemallocation system

• The collaboration within Eurotransplant offers The collaboration within Eurotransplant offers additional benefits to participating centers and additional benefits to participating centers and countries, e.g. trough improved patient oriented countries, e.g. trough improved patient oriented allocation, help for high urgency patient and for allocation, help for high urgency patient and for special patient group as well as avoidance of donor special patient group as well as avoidance of donor organ lossorgan loss

Promotion and support of Tx in an extended European Community

•Stepwise approach to incorporate new members Stepwise approach to incorporate new members within the within the framework of a preliminary cooperation framework of a preliminary cooperation agreement in order to agreement in order to provide immediate support with provide immediate support with regard to urgent pts., highly regard to urgent pts., highly

sensitized pts., childrensensitized pts., children

•Ultimate goal is a full membership within an Ultimate goal is a full membership within an acceptable timeframeacceptable timeframe

Increase of the donor pool for all patients to Increase of the donor pool for all patients to improve improve outcome outcome

Eurotransplant GoalsEurotransplant Goals OutlookOutlook

eurotransplant: an example of success for cross-border cooperation bruno meiser eurotransplant...

Documents

organ transplantation

transplantation outcome

transplantation results

organ availability

national allocation

transplant outcome

objective selection

donor organseurotransplant