About Eurotransplant
Eurotransplant policy on registration of non-resident patients
1. Introduction
The matter of non-resident transplantation is in most regards independent of the number of such transplants. The real concern of non-resident transplantation is that it might influence the social acceptance of donation of organs and transplantation in general. This could endanger the willingness to donate organs. As non-resident transplantation is easily linked to organ trafficking and/or tourism, this potentially endangers ET's good reputation.
Within the ET countries there is, with the exception of Belgium, no legislation in the area of non-resident transplantation. ET is internationally expected to provide a clear position and regulation regarding this topic. The political and legal problems of the non-resident issue should in fact be addressed by the national governments / authorities. Currently the national authorities in most countries have up till now not developed national legislation concerning this subject. Given this situation ET feels obliged to deal with this problem by establishing this policy. It demonstrates ET's commitment to the community and the national authorities it is serving. The policy is a normative, not a legal rule for which reason it cannot be legally enforced. Nevertheless it is for the authority and credibility of ET very important that all members stick to this rule.
2. Policy concerning the listing of non-resident patients on the ET waiting lists
1. Definition of RESIDENT
A. ET defines patients as 'RESIDENT' when the patient:
- carries the nationality of an ET country or
- legitimately lives or works in an ET country for a longer period than 6 months or
- if the patient is defined as such according to national legislation of the country where the patient is listed.
Other patients are considered as non-resident patients; the 5% rule, as mentioned in par. 3 of this document, is applicable for this category of patients.
B. In the event that there is an active twinning agreement (approved by the Board of ET) between an ET center with a center or country outside ET, patients from this twinning center / country outside ET with the nationality of that country are counted as residents.
C. The former ET rule that patients are considered to be 'residents' in the event of receiving a retransplantation after having had their first transplant in an ET country, is not longer valid for new registrations on the waiting list.
2. Verification of residency status
a. The residency status is verified by:
- passport or
- official document of residency or
- working permit or
- citizenship applicable in ET countries where citizenship is considered to be equal with residency or
- rules specified by the national authority.
b. For the registration in the ENIS computer system of ET the following categories will be
distinguished:
1. national residents;
2. non-national ET residents;
3. non-national residents outside ET but within the EU;
4. all other residents.
It is the responsibility of the transplant center to verify the residency status of each patient and to register the right nationality and category (1, 2, 3 or 4) at time of listing (or in case of change in residency status) in the ENIS computer system and to inform ET on this status.
3. Description of the 5% rule
a. The number of non-resident listings per center for liver, heart and lung patients should stay below 5% per year of the total number of patients transplanted with a deceased donor in the previous calendar year.
b. All post-mortem transplantations are used for the determination of the compliance to the 5% non-resident rule with the exception of:
- Pediatric patients, who are successfully transplanted with a left lateral liver split, in the event the (extended) right lobe of the same donor organ is also transplanted;
- Patients from a non-ET twinning country or center who are listed on the waiting list of the ET twinning center, in case of an approved twinning agreement.
c. Each transplantation (including retransplantation) is counted separately.
d. A transgression of this ratio (5%) will be communicated by ET to the center concerned and to the Board of ET on a regular basis, at least annually.
e. The 5% rule is not applicable for kidney and pancreas patients with understanding that these patients are not allowed to be registered on the ET waiting list.
4. Living donors
a. Living donor transplantation in non-residents is not included in the calculation of the 5% rule as described in par. 3 of this document.
b. ET is not responsible for living donor selection. The responsibility for the complete living donor procedure is at the transplant center.
c. Living donor transplantation with non-ET residents should comply with the existing ET recommendation on living donation (REC01.06).
d. Non-resident living donors evolving to a state of terminal organ failure are eligible for listing within the 5% rule.
