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NDT Advance Access published online on November 2, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh506
© 2004 by European Renal Association - European Dialysis and Transplant Association
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Received March 5, 2004
Accepted August 31, 2004

Nephrology, Dialysis and Transplantation News

Expanding the donor pool to increase renal transplantation

Bernard Cohen 1*, Jacqueline M. Smits 1, Bernadette Haase 2, Guido Persijn 1, Yves Vanrenterghem 3, and Ulrich Frei 4

1 Eurotransplant International Foundation, Leiden, The Netherlands
2 Dutch Transplantation Foundation, Leiden, The Netherlands
3 UZ Gasthuisberg, Nephrology, Leuven, Belgium
4 Humboldt Universität zu Berlin, Charité Campus-Virchow-Klinikum, Berlin, Germany

* To whom correspondence should be addressed.
Bernard Cohen, E-mail: bcohen{at}eurotransplant.nl



  Abstract

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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