L'assemblée générale de la Fédération européenne des Greffés cardiaques et pulmonaires Dimitri Mikhalski Brussels

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Organ transplantation is one of the great medical success stories of the 20th century

Europe Eurotransplant Foundation Scandia Transplant European Transplant Coordinators Organization European Society of Transplantation European Heart and Lung Transplant Federation Austria: Austrotransplant Croatia: Donor Network of Croatia Czech Republic: Czech Transplantation Coordinating Centre (KST) Estonia: Tartu Hospital University France:Agence de la biomédecine: French Federation for Organ Donation: Germany: Deutsche Stiftung Organtransplantation (DSO) Greece: Hellenic National Transplant Organization Italy: Centro Nazionale Trapianti (CNT) Lithuania:Lithuanian Bureau on Organ Transplantation Netherlands: Nederlandse Transplantatie Vereniging Norway: Rikshospitalet / Radium Hospitalet Poland: Poltransplant Romania: National Transplant Agency Slovakia: Slovaq Centre on Organ Transplantation Slovenia: Institute of the Republic of Slovenia for the Transplant of Organs and Tissues Slovenija Transplant Spain:Organización Nacional de Trasplantes (ONT) Sweden: Swedish Council for Organ and Tissue Donation Switzerland:Swisstransplant for Solid Organ and Partial Tissue United Kingdom:UKTransplant: British Organ Donor Society:

EUROTRANSPLANT

Increasing demand for organs Currently, demand for organs exceeds their availability in all EU Member States and demand increases faster than organ donation rates in most Member States

THE EU - A DIVERSE LANDSCAPE THE EU - A DIVERSE LANDSCAPE Source: CoE/ONT = Eurotransplant 2 = Scandiatransplant

6 October and 8 November 2006 among 28,584 people in the 25 European Union Member States In June 2006, the Directorate General Health and Consumer Protection (SANCO) of the European Commission launched an open consultation on organ donations and transplantations

Jean-Baptiste-Gabriel-Joachim Dausset Karl Landsteiner Jan Janský Jon J. van Rood HLA-type of donor and recipients influenced the results of transplantation

History Jean Dausset, a French scientist: In 1958discovered genetic characteristics of leucocytes on cell walls that differ for each individual. In 1965 described the first group of antigens which is now known as the HLA-system (human leucocyte antigens). Dr. Jon J. van Rood, from Leiden proved that matching the HLA-type of donor and recipient had a positive effect on the outcome of transplantation. In 1967 he founded Eurotransplant.

A new approach Transplant surgeons matched donor and patient mainly by blood type. Patients had to wait until a matching donor was found in the local center. In Leiden, Dr. Jon J. van Rood convinced that the HLA-type of donor and recipients influenced the results of transplantation. To make the best possible match he needed a central database of all patients waiting for a donor kidney. From ransplant centers in 3 countries participated voluntarily and the information of their transplant candidates was registered by “Eurotransplant”. The centers reported donors and Eurotransplant made the best possible match. Until the mid sixties

1967 Human leucocyte antigens A proposal for international Cooperation in organ transplantation Jon J. van Rood

The outcome of kidney transplants improved spectacular !!!!!!!

Eurotransplant is an international non-profit organ exchange organization responsible for the organ allocation in 7 European countries Transplant centersDonor hospitalsTissue typing laboratories cooperation

Eurotransplant's aims As mediator between donor and recipient, Eurotransplant plays a key role in the allocation and distribution of donor organs for Tx.

The major purposes of the organization to achieve optimal matching between the available donor organs and the recipients addressing the needs of special patient groups a high utilization rate of available donor organs via transparent, scientifically-based allocation rules

Eurotransplant foundation's main target To ensure an optimal use of available donor organs. The allocation system is based upon medical en ethical criteria. Through conducting and facilitating scientific research,> a constant improvement of transplant outcomes.

Rapid growth What started as a scientific experiment soon became a foundation At the end of 1970 Eurotransplant was active for 68 centers in 6 countries: Austria, Belgium, Luxembourg, West-Germany, the Netherlands Switzerland. Eventually Switzerland withdrew in 1991 East-Germany joined in in 1999 by Slovenia in 2007 by Croatia. In Eurotransplant started allocating donor and In 1988 the allocation of started Since 1999 are exchanged. 7

About Eurotransplant framework Austria, Belgium, Croatia, Germany, Luxembourg, the Netherlands Slovenia Renal 66 Heart 39 Lung 25 Liver 37 Pancreas 38 Intestin 6 Transplant centers Population 125 million EUROTRANSPLANT

Organization Eurotransplant is fully connected with the members of its community. The organizational structure is democratic: with a Board of Directors, a Board of management, an Assembly, a Council, 8 Advisory Committees and a Working Group. At every level it is arranged that the national authorities, the national scientific transplant societies the transplant programs in the centers have their input in the policies and practices of Eurotransplant

The Eurotransplant International Foundation supports the transplant community as a service organization for donation and transplantation

To produce its services, Eurotransplant manages the following core processes: Allocation Algorithm development Registry

Constant improvement Since its foundation, Eurotransplant has allocated donor organs for transplants. In 1996 the Eurotransplant Kidney Allocation System (ETKAS) was introduced. This sophisticated system supports a patient oriented allocation of kidneys, balancing medical and ethical principles. In 1996 the Acceptable Mismatch program started fulfilling its purpose: finding a suitable organ for highly immunized patients. In 1999 the Eurotransplant Senior Program, also known as the ‘old for old’- program, started. Organs of donors of 65 years or older are allocated to recipients of the same age group, without taking into account the tissue characteristics.

2010

Allocation Eurotransplant plays a key role in the allocation and distribution of donor organs for transplantation. The allocation system is objective, transparent, reproducible and valid. It is designed to make the best match possible given the circumstances. After removal a donor organ has to be transplanted within a few hours. Eurotransplant central office  specially trained staff,  24 hours a day,  7 days a week.

One waiting list This is the basic principle of making the best match possible have access Central computer database Eurotransplant All transplantation centers enter the general and medical information of their recipients and the donor profiles

When the information is entered into the central database, the patient is put on the (inter) national waiting list. At that point, the waiting time starts. (NB :The waiting time for kidney patients starts on the date of the first dialysis.)

Making the match Donor becomes available >  the regional tissue-typing lab determines the donor's blood group and tissue characteristics.  All (medical) information about the donor as well as information about the specific organs are transferred into the Eurotransplant database.  Eurotransplant generates a match list for each donor organ.  The match list is generated by a computer algorithm that takes into account all medical and ethical criteria.

the match list is the same (no matter which duty desk officer arranges the allocation) the same question will lead to the same answer every step in the process can be accounted for the system is based upon valid medical and ethical criteria (that are supported by consensus within the transplant community) Valid: Transparent:Reproducible: Objective: The allocation system is:

The match is based upon two general principles : 1.Expected outcome 2.Urgency (as determined by experts in an objective and transparent way) Furthermore, the following is taken into account: National organ balance - for Eurotransplant pursuits a reasonable balance in the exchange of organs between countries Waiting time

Offering donor organ(s) The donor organs are offered to recipients according to their ranking on the match list. The Eurotransplant informs the transplant coordinators and physicians in the patient’s transplant center. The second patient on the match list. The treating physicians decide whether or not to accept the organ. Eurotransplant establises contact between the donor hospital and the transplant center. The exact time of the procurement is determined,the transplant hospitals is arranged.  If there are no suitable recipients within the Eurotransplant area, Eurotransplant contacts a sister organization, such as the British NHSBT or Scandiatransplant.

Democratization Starting in 1994 In 1996 an Assemby was installed From then on the members of the Advisory Committees were selected by the national transplant societies. After almost thirty years Jon van Rood resigned and was succeeded by Prof. Dr. Yves Vanrenterghem as President, until he retired in 2005 and Prof. Dr. Bruno Meiser was elected. in 2009 the most recent step was the formation of the national authorities

Offering a permanent platform for exchange of information National authorities of the member states Eurotransplant Board Eurotransplant Council Eurotransplant

47 ORGAN DONATION AND TRANSPLANTATION: POLICY ACTIONS AT EU LEVEL 10 PRIORITY ACTIONS ( ) Increasing organ availability Make transplantation systems more efficient and accessible Improve quality and safety EU LEGAL FRAMEWORK Quality and Safety Requirements

48 Action Plan > Cooperation between Member States Promote the role of transplant donor coordinators in every hospital where there is a potential for organ donation Promote Quality Improvement Programmes in every hospital where there is a potential for organ donation Promote Living Donation Programmes in the EU Member States Enhance the organisational models of organ donation and transplantation Facilitate the interchange of organs between national authorities Improve knowledge and communication skills of health professionals and patients support groups on organ transplantation THE ACTION PLAN

Increase Organ Availability Enhance Efficiency and Accessibility of Transplantation Systems Quality and Safety CHALLENGES OBJECTIVES 1 full potential of deceased donation 2 living donation as complementary 3 Increase public awreness 4 support and guide TX Systems 5 improve quality and safety PRIORITY ACTIONS 1 transplant coordinators 2 quality improvement programmes 3 living donation programmes 4 communication skills of health professionals 5 information on citizens rights 6 enhance organisational models 7 EU-wide agreements 8 interchange of organs 9 evaluation of post transplant results 10 common accreditation system PROJECTS

ACTION PLAN DIRECTIVE Adoption Proposal Adoption? Mid-term review Entry into force? Evaluation