One waiting list

All transplantation centers within the member states of Eurotransplant have access to the central computer database. In this database, the transplantation centers enter the general and medical information of their recipients along with the recipient profile and the donor profile. These profiles contain the characteristics of patients and donors. This is the basic principle of making the best match possible given the circumstances. 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. The waiting time for kidney patients starts on the date of the first dialysis.

Making the match

As soon as a donor becomes available within the Eurotransplant area, the regional tissue-typing laboratory determines the donor’s blood group and tissue characteristics. All relevant (medical) information about the donor as well as information about the specific organs are transferred into the Eurotransplant database. Eurotransplant generates a so-called match list for each donor organ. The match list is generated by a complicated computer algorithm that takes into account all medical and ethical criteria.

The allocation system is

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

The match is based upon two general principles

  • Expected outcome
  • 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 duty desk officers of Eurotransplant inform the transplant coordinators and physicians in the patient’s transplant center. They also inform the transplant center of the second patient on the match list. The donor information is made available to both transplant centers. The treating physicians decide whether or not to accept the organ.

As soon as the organ is accepted, the physician contacts the patient. Eurotransplant establishes contact between the donor hospital and the transplant center. The exact time of the procurement operation is determined. This happens in consultation with the transplant coordinator of the donor hospital. At the same time, the (crossborder) transportation of the organs from the donor hospital to the recipient(s) in the transplant hospitals is arranged.

If there are no suitable recipients within the Eurotransplant area, Eurotransplant contacts a sister organization.

ESP

On January 4 1999, the Eurotransplant Senior Program (ESP) was implemented within the Eurotransplant kidney allocation scheme. This program has been developed because of an increasing number of older donors and recipients.

The ESP allocates kidneys from post-mortem donors of 65 years and older to patients of 65 years and older. In most of the countries the match is generated without the use of a donor HLA typing, but in the Netherlands, Belgium and Hungary the HLA is mandatory to start the match. The ESP aims at a cold ischaemic period (CIP) that is as short as possible.

Kidneys from an ESP donor that cannot be allocated or are not accepted via the match list are allocated through extended allocation followed by rescue allocation.

National allocation rules

  • Austria
    Kidneys from ESP donors are allocated to ESP patients from the reporting center’s local waiting list.
  • Germany
    Kidneys from ESP donors are allocated to ESP patients from the corresponding region as defined by the organ procurement organization Deutsche Stiftung Organtransplantation (DSO). Kidneys from ESP donors are first allocated to ESP patients registered within the same sub-region as the donor and then to ESP patients registered within the other subregions.
  • Belgium/Luxembourg and Hungary
    Kidneys are allocated to ESP patients of the local or regional centers before ESP patients of national centers.
  • The Netherlands, Croatia, Slovenia
    In the Netherlands, Croatia and Slovenia, kidneys from ESP donors are allocated to ESP patients according to the national waiting list.

Choice of allocation scheme

  • Germany
    In Germany recipients aged 65 years or older must choose for either being included in the ESP/ESDP or the ETKAS program. These programs are mutually exclusive.