NDT Advance Access originally published online on November 2, 2004
Nephrology Dialysis Transplantation 2005 20(1):34-41; doi:10.1093/ndt/gfh506
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Nephrol Dial Transplant Vol. 20 No. 1 © ERA-EDTA 2004; all rights reserved
Nephrology, Dialysis and Transplantation News
Expanding the donor pool to increase renal transplantation
1 Eurotransplant International Foundation, 2 Dutch Transplantation Foundation, Leiden, The Netherlands, 3 UZ Gasthuisberg, Nephrology, Leuven, Belgium and 4 Humboldt Universität zu Berlin, Charité Campus-Virchow-Klinikum, Berlin, Germany
Correspondence and offprint requests to: Bernard Cohen, MEc, PhD, Director, Eurotransplant International Foundation, PO Box 2304, 2301 CH Leiden, The Netherlands. Email: bcohen{at}eurotransplant.nl
Introduction. The goal of the Eurotransplant renal allocation scheme is to provide every patient on the waiting list with a reasonably balanced opportunity for a donor offer. New initiatives were taken in order to maximize donor usage while maintaining a successful transplant outcome.
Methods. Two Eurotransplant projects were launched in order to accommodate changes in donor and recipient profiles. A re-addressing of the non-heart-beating donor pool was undertaken and an allocation scheme in which organs from donors aged >65 are allocated to recipients aged >65 [the Eurotransplant Senior Programme (ESP)] was introduced.
Results. Especially in The Netherlands, an enormous increase in the number of non-heart-beating donor kidneys has been observed, however with a pace-keeping reduction in heart-beating donors. The organization-wide implementation of the ESP has been successful. The 3 year graft survival rates for these age-matched transplants were as good as the human leukocyte antigen (HLA)-matched transplants (64 vs 67%) (P = 0.4).
Conclusion. Within the framework of sound research, the utmost flexibility and creativity is needed to keep or even increase the number of renal transplants when faced with a quantitatively stagnating but qualitatively deteriorating donor pool. Both the non-heart-beating donor protocol and the ESP have proven to be quite successful in achieving this goal without compromising the outcome for the individual end-stage renal disease patient.
Keywords: expanded criteria donors; non-heart-beating donors; renal allocation
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