Expanding the donor pool to increase renal transplantation

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2005-01, Vol.20 (1), p.34-41
• Main Authors: Cohen, Bernard, Smits, Jacqueline M., Haase, Bernadette, Persijn, Guido, Vanrenterghem, Yves, Frei, Ulrich
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Child, Preschool; Emergency and intensive care: renal failure. Dialysis management; Europe; expanded criteria donors; Female; Germany; Humans; Incidence; Intensive care medicine; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - surgery; Kidney Transplantation - methods; Kidney Transplantation - statistics & numerical data; Living Donors - statistics & numerical data; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Netherlands; non-heart-beating donors; Program Development; Program Evaluation; renal allocation; Renal failure; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue and Organ Procurement - organization & administration; Tissue Donors - statistics & numerical data
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfh506

Introduction. The goal of the Eurotransplant renal allocation scheme is to provide every patient on the waiting list with a reasonably balanced opportunity for a donor offer. New initiatives were taken in order to maximize donor usage while maintaining a successful transplant outcome. Methods. Two Eurotransplant projects were launched in order to accommodate changes in donor and recipient profiles. A re-addressing of the non-heart-beating donor pool was undertaken and an allocation scheme in which organs from donors aged >65 are allocated to recipients aged >65 [the Eurotransplant Senior Programme (ESP)] was introduced. Results. Especially in The Netherlands, an enormous increase in the number of non-heart-beating donor kidneys has been observed, however with a pace-keeping reduction in heart-beating donors. The organization-wide implementation of the ESP has been successful. The 3 year graft survival rates for these age-matched transplants were as good as the human leukocyte antigen (HLA)-matched transplants (64 vs 67%) (P = 0.4). Conclusion. Within the framework of sound research, the utmost flexibility and creativity is needed to keep or even increase the number of renal transplants when faced with a quantitatively stagnating but qualitatively deteriorating donor pool. Both the non-heart-beating donor protocol and the ESP have proven to be quite successful in achieving this goal without compromising the outcome for the individual end-stage renal disease patient.