Johannesburg Region Allocation of Deceased Donor Kidneys Controversies Meeting 7-8 May 2011 Prof R.S.Britz and Nephrology Panel Kim Crymble Transplant Coordinator.

In the beginning..prior to 2004 Kidneys were allocated in a 50 / 50 split between the state and the private sector to patients on the waiting lists. The allocation was on Hla matches and negative cross match. High PRA’s viewed as a reason not to allocate an organ even with a negative cross match a decision made by SANBS not the attending Nephrologists.

Regional Demographics In Johannesburg we have 3 Health Care Providers where Renal Transplant are performed CMJAH as the State Sector facility who provides Renal Transplantation for all State listed Patients Johannesburg and surrounding areas but also from Klerksdorp and Polokwane. Netcare ( Milpark and Garden City Clinic) and Wits Donald Gordon Medical Centre who provide Transplant Care for the Privately funded Patients.

Health for all and access to Care It was always viewed that the State Sector Patient should always have equal access to Health Care as Organs Donated are from the community and should be for the benefit to all within the community. So despite where donors are identified and harvested we had an allocation of one kidney to state and one kidney to the private list.

Private Vs Public Sector Harvested donors Johannesburg Region.

Total Number of Donors Johannesburg 2010: 35 Donors

The current Allocation. The Allocation has evolved in the last few years. Based on an evaluation of all the currently used allocation systems worldwide and adapted for our Region. Any decision related to the current system has been debated and accepted by all members of the Academic Renal Panel in Johannesburg.

Deceased Donor Kidney Allocation The allocation system is Point based Mostly a Time based system Excel spread sheet run after defining system Scrapped 50:50 system in 2010 Now everyone on one allocation list State and Private Kidneys allocated to individuals not centres State organ still largely sponsored by private

How does the Point System work. 1 year = 1 point Minimal (No) HLA weighting 2 nd and subsequent transplants penalized by 3 points Paeds get preference (extra points) Only 6 high PRA patients X matched at any time Top 30 patients cross matched

Age matched kidney allocation Non-Expanded criteria Kidneys Kidneys from Donors under the age of 55. Expanded Criteria Kidneys (ECK) Kidneys from Donors over the age of 55 or 2 of the following if the death has been due to a CVA, history of Hypertension Serum Creat levels are over 150. Allocated to > 40 yr old recipients only >55 yr old patients only eligible for ECK

Minimum Donor Data required for allocation of Kidneys. Non Expanded Criteria Donor Age Expanded Criteria Donor Age / Date of Birth Serum Creat Medical History

Recipient Data Independent Data capturer Enters data and administers the list For all Kidney Transplant recipients in Johannesburg Information required: JHB Renal Panel form Patients HLA and current PRA’s Physician assessment form which claims fitness for Transplant.

Allocation Spreadsheet: Donor ID : GROUP O EXPANDED CRITERIA DONOR KIDNEY? N MUST SORT THIS COLUMN ASCENDING! Date: 09/05/2011KIDNEY LISTING ORDER X Match +V e? PT NO.. Name PRA Urgent?Hosp Poi nts 1Y71 KHES**, SIP** 85 JHB PAEDS 10 ADDITIO NAL URGENT PATIENT 2N73 KH**, X** 83 CHB 10 NAME PT NO.PRA X Match +Ve? Urge nt? B Group Patient? 3 Y49 GEL***, T** 10 0 KLERK 9 Nil Y 4 N46 F**, H** 98 WITS 8 Allocated 1st, UNLESS there is an urgent listed in top 10

Thank You Queries to Professor R.S.Britz