Working with Eurotransplant to Optimise Organ Allocation

Ina Jochmans, MD, PhD University of Leuven, no relevant financial disclosures Phoenix Brussels & Antwerp in Belgium

http://earthobservatory.nasa.gov/IOTD 1958 anti-Mac J. Dousset

1965 HLA identification

1967 HLA-match Kidney J. van Rood 2014 Belgium 134 mi 1601 ~ 15,000 Transplant Centres:

40 5 23 > 7,000 organs/y

71 38 39 24% Eurotransplant factsheet 01/2015 EU directive

National Competent Authorities Transplant Transplant Donation Donation Allocation Allocation

OPO Eurotransplant Transplant centres Number deceased donors pmp <10

>25

Eurotransplant annual report 2014 DCD in only 3 countries

active programmes

Austria, Belgium, Netherlands

allowed, not active

Luxembourg, Slovenia

not allowed

Croatia, Germany, Hungary utilization urgency match outcome Median deceased donor age

54 y Donor age transplanted livers 100% 90% 25% 80% 70% 60% 20% 50% 40% 65+ 30% 56-64

20% 16-55 10% 0-15 0% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Organ utilization of reported deceased donors

80% Liver utilization 90%

85% Donor age

80% 0-15 16-55 75% 56-64 65+ 70%

65% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Liver utilization 90%

85% Donor age 80%

65+ 75%

70%

65% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Liver recipient age

100% 90% 80% 70% 60% 65+ 50% 56-64 40% 16-55 30% 0-15 20% 10% 0% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 DCD Liver utilization 250

200

150 Effective DCD 100 DCD livers transpl

50

0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 HU ACO T > ET •International •International •Regional / National •~ 10% •< 1% •Offering Scheme Recipient offer Acute liver () failure Regular Mixed model - DBD recipient offer Extended - DCD centre offer

Rescue Centre offer Offering scheme of transplanted livers

100% 90% Extended or Rescue 80% 70% 60% Regular 50% Deviated offering 40% Regular offering 30% 20% 10% 0% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Calc MELD Match = 9,57 ln Cr + 3,78 ln Bili + 11,2 ln INR + 6,43 MELD Exc MELD  increase points / 3 mo Donor Match Waiting profile • “Standard” criteria List time country specific • “Non-Standard” • audit group • BE, GER, NL

Region

Eurotransplant manual 2015 Median (IQR) Calc MELD

18 (12-25) Recipient driven offering according to match list 15 (12-21) 19 (12-32) 13 (11-18) Mixed model - DBD recipient driven 16 (10-27) - DCD centre pick 17 (14-22) 16 (12-22 ) Centre driven offering with a match list match MELD transplanted patients

100% 90% 80% 70% 60% 50% Calc MELD 40% Exc MELD 30% 20% 10% 0% 2007 2008 2009 2010 2011 2012 2013 2014 2015 12

10 median CIT

8

6

4

Cold ischemia time (h) time ischemia Cold 2

0 2007 2008 2009 2010 2011 2012 2013 2014 2015 Median waiting time (mo) 100% 90% 80% 70% 60+ 60% 24-59 50% 12-23 40% 6-11 30% 0-5 20% 10% 0% 2014 Waitlist removals Recipient survival post liver transplant

Donor age (y)

0-15 (397) 16-55 (6,786) 56-64 (2,125) ≥65 (2,744)

2007 - 2014 Recipient survival post liver transplant

DCD (535) DBD (10,621)

Overall retransplant 13% 2007 - 2014 Liver offering in Eurotransplant is …

• Unique

• Effective

• Complex  scope for unification

• Need for international monitoring outcome References

Eurotransplant data are available at www.statistics.eurotransplant.org

Eurotransplant annual reports available at www.eurotransplant.org