Eurotransplant: An example of success for cross-border cooperation Bruno Meiser Eurotransplant International Foundation, Leiden, Netherlands Dept. of Cardiac Surgery University of Munich/Grosshadern Medical Center

Scandiatransplant UK Transplant AdB, France Swiss Transplant Lusotransplante ONT, Spain EurotransplantBalttransplantPoltransplantCzechtransplantHungarotransplant CNT, Italy HNTO, Greece 12 European Organ Exchange Organisations

5966 OEOs, by number of deceased donor 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: An example of success for cross-border cooperation

1967 A proposal for international cooperation in organ transplantation (based on HLA matching): EUROTRANSPLANT INTERNATIONAL FOUNDATION Prof. Dr. J.J. van Rood

2007 ET/Ministers conference: Affirmation of the ET mission

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: An example of success for cross-border cooperation

Eurotransplant mission/goals International non-profit organization, coordinating national allocation and international exchange of scarce organs

Eurotransplant mission/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:

Eurotransplant mission/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

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

Eurotransplant mission/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 - - 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 Commissionar for Health & Consumer Protection, Androulla Vassiliou in September 2008

International Eurotransplant Foundation: 125 millionen inhabitants in 7 states Zagreb

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: An example of success for cross-border cooperation

Leiden ET Transplantion-Programs (n=216)

Board Ethics Com. Organ Procurement Com. ETKAC ELIAC ETHAC EPAC ET Board + Advisory Committees Financial Com. Tissue Typing Adv. Com. Comp. Serv. Work. Group

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: An example of success for cross-border cooperation

The question of allocation equity is caused by the discrepancy between

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

Post-mortem donation per million population ET

Organ donation rates in Europe Organ donors p.m.p. 2007

, Organ donation rates in ET Organ donors p.m.p. 2007

Organ donors p.m.p vs , Organ donation rates in ET

Total in the EU 4,317 persons (12 persons/day) Deaths on waiting lists – European Union 2007

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: An example of success for cross-border cooperation

Organexchnge in the ET-area Kidney transplantation The Netherlands GermanySlovenia AustriaBelgium

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: An example of success for cross-border cooperation

Kidney graft survival and HLA-ABDR mismatches Adult first cadaver kidney-only transplants Post-transplant time (m) P= % 83% 71%

100%10073total 0,4%446 2,4 % ,5 % ,2% ,6 % Percentage No. of transplantations No. of mismatches HLA-matching in kidney transplantation ET , non-ESP patients 21,6 % 8,3 %

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: An example of success for cross-border cooperation

n=201 (16%)n=1053 (84%) HU transplantion liver Waiting time [n=1254] Children (<16 a) Adults (16+ a) Median waiting time: 2 d (both groups)

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: An example of success for cross-border cooperation

Mean waiting time kidney-transplantation Impact of the AM-program on highly-immunized patients, Eurotransplant 2006 n=26 n=3137n=47

International organ exchange in kidney transplantation Impact for selected patient groups Eurotransplant

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: An example of success for cross-border cooperation

Development of donation numbers for different donor age groups Reported kidney donors, Eurotransplant, Donor age groups Number of donors (in relation to 2000)

Cecka, et al. Transplantation 2006; 81: Turn-down of kidneys accord. to donor age: Eurotransplant vs. U.S.A.

National organ import and export for different blood groups and countries Slovenia Netherlands Germany Belgium 100% 38,5% 18,4% 73,5%36,7%53,4% 18,8% 10,7% 29,5%22,1%100% 28,9% 14,4% 73,9%41,2%55,1% 18,3% 10,7% 34,5%19,7%Austria ABAABA ImportExport

Slovenia Netherlands Germany Belgium 100% 38,5% 18,4% 73,5%36,7%53,4% 18,8% 10,7% 29,5%22,1%100% 28,9% 14,4% 73,9%41,2%55,1% 18,3% 10,7% 34,5%19,7%Austria ABAABA ImportExport

Summary The donation rates in many European / some ET countries are still unsatisfactory; there is an increasing gap between donation rate and demand for transplantationThe donation rates in many European / some ET countries are still unsatisfactory; there is an increasing gap between donation rate and demand for transplantation ET has successfully served more than pts. by allocating kidney-, liver-, heart-, pancreas-, and lung grafts through a transparent, quality and safety oriented allocation systemET has successfully served more than pts. by allocating kidney-, liver-, heart-, pancreas-, and lung grafts through a transparent, quality and safety oriented allocation system The collaboration within Eurotransplant offers additional benefits to participating centers and countries, e.g. trough improved patient oriented allocation, help for high urgency patient and for special patient group as well as avoidance of donor organ lossThe collaboration within Eurotransplant offers additional benefits to participating centers and countries, e.g. trough improved patient oriented allocation, help for high urgency patient and for special patient group as well as avoidance of donor organ loss

Promotion and support of Tx in an extended European Community Stepwise approach to incorporate new members within the framework of a preliminary cooperation agreement in order to provide immediate support with regard to urgent pts., highly sensitized pts., childrenStepwise approach to incorporate new members within the framework of a preliminary cooperation agreement in order to provide immediate support with regard to urgent pts., highly sensitized pts., children Ultimate goal is a full membership within an acceptable timeframeUltimate goal is a full membership within an acceptable timeframe  Increase of the donor pool for all patients to improve outcome  Increase of the donor pool for all patients to improve outcome Eurotransplant Goals Outlook