2008

EUROTRANSPLANT INTERNATIONAL FOUNDATION A n n u a lR e p o r t2 0 08 63082 om 2005 29-06-2006 13:40 Pagina 1 Pagina 13:40 29-06-2006 2005 om 63082 2008

Edited by Arie Oosterlee and Axel Rahmel Eurotransplant Aims

Eurotransplant mission statement

Mission

Service organization for transplant candidates through the collaborating transplant programs within the organization.

Goals

• To achieve an optimal use of available donor organs and tissues

• To secure a transparent and objective selection system, based upon medical and ethical criteria

• To assess the importance of factors which have the greatest influence on waiting list mortality and transplant results

• To support donor procurement to increase the supply of donor organs and tissues

• To further improve the results of transplantation through scientific research and to publish and present these results

• Promotion, support and coordination of organ donation and transplantation in the broadest sense of terms

CIP-GEGEVENS KONINKLIJKE BIBLIOTHEEK, DEN HAAG

Annual Report/Eurotransplant International Foundation.–Leiden: Eurotransplant Foundation. -III., graf., tab. Published annually Annual report 2008 / ed. by Arie Oosterlee and Axel Rahmel ISBN-13: 978-90-71658-28-0 Keyword: Eurotransplant Foundation; annual reports.

2 Table of contents

- Board of Eurotransplant International Foundation 5

- TRANSPLANT PROGRAMS AND THEIR DELEGATES IN 2008 6 - Renal programs 6 - Heart programs 7 - Lung programs 8 - Liver programs 9 - Pancreas (islet) programs 10 - Tissue typing laboratories 11

- Foreword 13

1. Report of the Board and the central office of 14 Stichting Eurotransplant International Foundation 1.1 General 14 1.2 Policy 17 1.3 Quality Assurance & Safety 19 1.4 Advisory Committees 20 1.5 Recommendations approved 23

2. Eurotransplant: donation, waiting lists and transplants 26 - Introduction 26 Table 2.1 Number of deceased organ donors used for a transplant, by country of origin, from 2004 to 2008 26 Table 2.2(i) Number of deceased organ donors used for a transplant, by organ, from 2004 to 2008 27 Table 2.2(ii) Number of deceased organ donors used for a transplant, by organ and donor country, in 2008 27 Table 2.3(i) Demographic data on deceased organ donors, used for a transplant, from 2004 to 2008 27 Table 2.3(ii) Demographic data on deceased organ donors, used for a transplant, in 2008 28 Table 2.4a(i) Number of donors, used in a transplant, by type of donor, from 2004 to 2008 28 Table 2.4a(ii) Number of donors, used in a transplant, by type and country of origin of donor, in 2008 28 Table 2.4b(i) Number of deceased donors, used in a transplant, by type of donor, from 2004 to 2008 28 Table 2.4b(ii) Number of deceased donors, used in a transplant, by type and country of origin of donor, in 2008 29 Table 2.4c(i) Non-heart beating donors from 2004 to 2008 29 Table 2.4c(ii) Non-heart beating donors in 2008 29 Table 2.4d(i) Transplants from NHB donors from 2004 to 2008 29 Table 2.4d(ii) Transplants from NHB donors in 2008 30 Table 2.5(i) Active Eurotransplant waiting list, by organ, as per December 31, from 2004 to 2008 30 Table 2.5(ii) Active Eurotransplant waiting list, by organ, as per December 31, 2008 31 Table 2.6(i) Registration events on the Eurotransplant waiting list, by organ from 2004 to 2008 31 Table 2.6(ii) Registration events on the Eurotransplant waiting list, by organ and country, in 2008 32 Table 2.7(i) Number of transplanted organs, by organ, by donor type, from 2004 to 2008 32 Table 2.7(ii) Number of transplanted organs, by organ, by donor type, by country of transplant, in 2008 32 Table 2.8(i) Transplants from 2004 to 2008 33 Table 2.8(ii) Transplants in 2008, by transplant country 34 Table 2.9(i) Mortality on the Eurotransplant waiting list, by date of death, from 2004 to 2008 34 Table 2.9(ii) Mortality on the Eurotransplant waiting list in 2008 34

3. Kidney: donation, waiting lists and transplants 35 Table 3.1(i) Deceased donors / kidneys in Eurotransplant, from 2004 to 2008 35 Table 3.1(ii) Deceased donors / kidneys in Eurotransplant in 2008 35 Table 3.2(i) Active kidney transplant waiting list, as per December 31, from 2004 to 2008 - characteristics 35 Table 3.2(ii) Active kidney transplant waiting list, as per December 31 , 2008 - characteristics 36 Table 3.3(i) Active kidney only transplant waiting list, as per December 31, from 2004 to 2008 - characteristics 36 Table 3.3(ii) Active kidney only transplant waiting list, as per December 31, 2008 - characteristics 36 Table 3.4(i) Kidney transplants - characteristics from 2004 to 2008 37 Table 3.4(ii) Kidney transplants - characteristics - 2008 38 Table 3.5(i) Living donor kidney transplants - kidney only - 2004 to 2008 39 Table 3.5(ii) Living donor kidney transplants - kidney only - 2008 40 Figure 3.1 Dynamics of the Eurotransplant kidney transplant waiting list and transplants between 1969 and 2008 40

4. Thoracic organs: donation, waiting lists and transplants 41 Table 4.1(i) Deceased donors / hearts in Eurotransplant from 2004 to 2008 41 Table 4.1(ii) Deceased donors / hearts in Eurotransplant in 2008 41 Table 4.2(i) Deceased donors / lungs in Eurotransplant from 2004 to 2008 41 Table 4.2(ii) Deceased donors / lungs in Eurotransplant in 2008 42 Table 4.3(i) Active heart transplant waiting list, as per December 31, from 2004 to 2008 - characteristics 42

3 Table 4.3(ii) Active heart transplant waiting list as per December 31, 2008 - characteristics 42 Table 4.4(i) Active heart only transplant waiting list as per December 31, from 2004 to 2008 - characteristics 42 Table 4.4(ii) Active heart only transplant waiting list as per December 31, 2008 - characteristics 43 Table 4.5(i) Active heart + lung transplant waiting list as per December 31, from 2004 to 2008 - characteristics 44 Table 4.5(ii) Active heart + lung transplant waiting list, as per December 31, 2008 - characteristics 44 Table 4.6(i) Active heart + lung transplant waiting list as per December 31, from 2004 to 2008 - characteristics 44 Table 4.6(ii) Active heart + lung transplant waiting list as per December 31, 2008 - characteristics 44 Table 4.7(i) Active lung transplant waiting list as per December 31, from 2004 to 2008 - characteristics 45 Table 4.7(ii) Active lung transplant waiting list as per December 31, 2008 - characteristics 45 Table 4.8(i) Active lung only transplant waiting list, as per December 31, from 2004 to 2008 - characteristics 45 Table 4.8(ii) Active lung only transplant waiting list, as per December 31, 2008 - characteristics 46 Table 4.9(i) Heart transplants from 2004 to 2008 - characteristics 46 Table 4.9(ii) Heart transplants 2008 - characteristics 47 Table 4.10(i) Heart + lung transplants from 2004 to 2008 - characteristics 48 Table 4.10(ii) Heart + lung transplants 2008 - characteristics 48 Table 4.11(i) Lung transplants from 2004 to 2008 - characteristics 49 Table 4.11(ii) Lung transplants 2008 - characteristics 50 Figure 4.1 Dynamics of the Eurotransplant heart waiting list and transplants between 1991 and 2008 50 Figure 4.2 Dynamics of the Eurotransplant heart + lung waiting list and heart + lung transplants and 50 Eurotransplant lung waiting list and lung transplants between 1991 and 2008

5. Liver and intestine: donation, waiting lists and tranplants 51 Table 5.1(i) Deceased donor livers in Eurotransplant from 2004 to 2008 51 Table 5.1(ii) Deceased donor livers in Eurotransplant in 2008 51 Table 5.2(i) Active liver transplant waiting list, as per December 31, from 2004 to 2008 - characteristics 52 Table 5.2(ii) Active liver transplant waiting list, as per December 31, 2008 - characteristics 52 Table 5.3(i) Active liver only transplant waiting list as per December 31, from 2004 to 2008 - characteristics 52 Table 5.3(ii) Active liver only transplant waiting list as per December 31, 2008 - characteristics 53 Table 5.4(i) Liver transplants from 2004 to 2008 - characteristics 54 Table 5.4(ii) Liver transplants 2008 - characteristics 54 Table 5.5(i) Living donor liver transplants - liver only - from 2004 to 2008 55 Table 5.5(ii) Living donor liver transplants - liver only - 2008 56 Figure 5.1 Dynamics of the Eurotransplant liver waiting list and liver transplants between 1991 and 2008 56 - Intestine transplants 2008 57 Table 5.6 Number of intestinal transplants performed in 2008 57

6. Pancreas and islets: donation, waiting lists and transplants 58 Table 6.1(i) Deceased donors / pancreas in Eurotransplant from 2004 to 2008 58 Table 6.1(ii) Deceased donors / pancreas in Eurotransplant in 2008 58 Table 6.2(i) Active pancreas transplant waiting list as per December 31, from 2004 to 2008 - characteristics 58 Table 6.2(ii) Active pancreas transplant waiting list as per December 31 , 2008 - characteristics 59 Table 6.3a(i) Active pancreas only transplant waiting list as per December 31, from 2004 to 2008 - characteristics 59 Table 6.3a(ii) Active pancreas only transplant waiting list as per December 31, 2008 - characteristics 59 Table 6.3b(i) Active kidney + pancreas transplant waiting list as per December 31, from 2004 to 2008 - characteristics 60 Table 6.3b(ii) Active kidney + pancreas transplant waiting list as per December 31, 2008 - characteristics 60 Table 6.4a(i) Pancreas transplants from 2004 to 2008 - characteristics 61 Table 6.4a(ii) Pancreas transplants 2008 - characteristics 62 Table 6.4b(i) Number of pancreas islet transplants from 2004 to 2008 62 Table 6.4b(ii) Number of pancreas islet transplants in 2008 62 Table 6.4c(i) Pancreas transplants from 2004 to 2008 - characteristics 62 Table 6.4c(ii) Pancreas transplants 2008 - characteristics 63 Figure 6.1 Dynamics of the Eurotransplant pancreas+kidney and islet+kidney waiting list, pancreas+kidney, islet+kidney, 63 pancreas and islet-only transplants between 1991 and 2008

7. Histocompatibility Testing 64 7.1 Introduction 64 7.2 Eurotransplant External Proficiency Testing Schemes 64 7.2.1 External Proficiency Testing on HLA typing 64 7.2.2 External Proficiency Testing on crossmatching 64 Table 7.1 Report of the crossmatch results 65 7.2.3 External Proficiency Testing Exercise on screening 65 7.3 Program for the highly sensitized patients in Eurotransplant 65 Table 7.2 Number of patients transplanted through the AM program 65 7.4 Other activities 66 Figure 7.1 Number of transplanted AM patients 66 Figure 7.2 Number of patients in the AM program in the respective year 66

8. Scientific Output in 2008 67 9. Annual Social Report Figures 73 10. Abbreviated financial statements 74

4 Board of Eurotransplant International Foundation as per December 31, 2008

Dr. B. Meiser, Munich president + on behalf of the thoracic section (A)

Prof.Dr. A.P.W.P. van Montfort, Utrecht secretary / treasurer (D)

Prof.Dr. R.J. Ploeg, Groningen on behalf of the kidney section (A)

Prof.Dr. F. Mühlbacher, Vienna on behalf of the kidney section (A)

Prof.Dr. D. Ysebaert, Antwerp on behalf of the kidney section (A)

Prof.Dr. W. Schareck, Rostock on behalf of the pancreas section (A)

Prof.Dr. G. Laufer, Innsbruck on behalf of the thoracic section (A)

Prof.Dr. D. Van Raemdonck, Leuven on behalf of the thoracic section (A)

Prof.Dr. K-W. Jauch, Munich on behalf of the liver section (A)

Prof.Dr. X. Rogiers, Gent on behalf of the liver section (A)

Dr. J. Mytilineos, Ulm on behalf of the tissue typing section (A)

Prof.Dr. P. Schotsmans, Leuven ethics advisor (D)

Prof.Dr. R. Steininger, Vienna on behalf of the Austrian Transplant Society (B)

Prof.Dr. V. Donckier de Donceel, Brussels (BR) on behalf of the Belgian Transplant Society (B)

Prof.Dr. J.W. de Fijter, Leiden on behalf of the Dutch Transplant Society (B)

Prof.Dr. U. Heemann, Munich on behalf of the German Transplant Society (B)

Dr. V. Sojar, Ljubljana on behalf of the Slovenian Transplant Society (B)

Dr. M. Bušić, Zagreb on behalf of the Republic of Croatia (B)

Prof.Dr. F.H.J. Claas, Leiden on behalf of the Eurotransplant Reference Laboratory (C)

The Board of Stichting Eurotransplant International Foundation consists of: 10 members A: members representing organ / tissue typing sections 6 members B: members representing national transplant societies 1 member C: head of the Eurotransplant Reference Laboratory 2 members D: one member being financial expert, one member representing society (ethicist)

5 TRANSPLANT PROGRAMS AND THEIR DELEGATES IN 2008

Definitions (according to Articles of Association of Stichting Eurotransplant International Foundation, version September 14, 2007)

Program: Any of the following transplantation areas: kidney, heart, lungs, liver, intestine, pancreas or any part of a specific organ and/or Tissue Typing, which have the approval of the competent and relevant authorities. (Article 2)

Delegate: Each center shall have the right to delegate one natural person in the Assembly for each program in which it performed transplantations during a year. On each reference date, the number of persons delegated (the “delegates”) by a center in the Assembly shall be reviewed. (Article 5.1) (If left open, then no delegate was appointed by transplant/tissue typing program or new program in 2008).

RENAL PROGRAMS DELEGATE

Austria GA Medizinische Universitätsklinik, Graz H. Holzer IB Chirurgische Universitätsklinik, Innsbruck C. Bösmüller OE Krankenhaus der Elisabethinen, Linz OL Allgemeines Krankenhaus, Linz O. Janko WG Universitätsklinik für Chirurgie, Wien F. Mühlbacher

Belgium AN Universitair Ziekenhuis Antwerpen, Edegem D. Ysebaert BJ Academisch Ziekenhuis der Vrije Universiteit, Brussel J. Sennesael BR ULB, Hôpital Erasme, Bruxelles K. Wissing GE Universitair Ziekenhuis, Gent P. Peeters LA Cliniques Universitaires St. Luc, Bruxelles M. Mourad LE Kinderdialyse Universitair Ziekenhuis Gasthuisberg, Leuven R. Van Damme-Lombaerts LG Centre Hospitalier Universitaire, Liège A. Deroover LM Universitair Ziekenhuis Gasthuisberg, Leuven Y. Vanrenterghem

Germany AK Universitätsklinikum der Rheinisch-Westfälischen TH, Aachen A. Homburg AU Zentralklinikum, Augsburg H. Weihprecht BB Ruhr Universität, Bochum R. Viebahn BC Charité-Campus Virchow Klinikum der Humboldt Universität, Berlin U. Frei BE Universitätsklinikum Benjamin Franklin, Berlin M. van der Giet BM Kliniken der Freien Hansestadt, Bremen F. Zantvoort BO Klinikum der Urologischen und Medizinischen Universität, Bonn R. Woitas DR Technischen Universität, Dresden J. Passauer DU Med. Einrichtungen der Heinrich-Heine-Universität, Düsseldorf K. Ivens ER Med. Einrichtungen der Universität Erlangen-Nürnberg, Erlangen C. Hugo ES Universitätsklinikum, Essen O. Witzke FD Klinikum Fulda, Fulda K. Fischer FM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt E. Scheuermann FR Klinikum der Albert-Ludwigs-Universität, Freiburg P. Pisarski GI Klinikum der Justus-Liebig-Universität, Gießen F. Renner GO Klinikum der Georg-August-Universität, Göttingen A. Obed HA Klinikum der Martin-Luther-Universität, Halle A. Hamza HB Klinikum der Ruprecht-Karls-Universität, Heidelberg HG Universitäts-Krankenhaus Eppendorf, Hamburg F. Thaiss HM Nephrologisches Zentrum Niedersachsen, Hann. Münden V. Kliem HO Klinikum der Medizinischen Hochschule, Hannover F. Lehner HS Klinikum der Universität des Saarlandes, Homburg/Saar U. Sester JE Klinikum der Friedrich-Schiller-Universität, Jena U. Ott

6 KI Klinikum Christian-Albrechts-Universität, Kiel F. Braun KL Klinik der Universität Köln-Lindenthal, Köln W. Arns KM Städtische Krankenanstalten Köln-Merheim, Köln W. Arns KK Klinik und Poliklinik für Kinderheilkunde der Universität Köln-Lindenthal, Köln W. Arns KS Westpfalz-Klinikum, Kaiserslautern LP Klinikum der Universität, Leipzig M. Bartels LU Klinikum der Medizinischen Universität, Lübeck M. Nitschke MA Klinikum der Stadt, Mannheim P. Schnülle MH Klinikum Rechts der Isar der Technischen Universität, München S. Thorban ML Klinikum Großhadern der Ludwig-Maximilians-Universität, München K-W Jauch MN Klinikum der Westfälischen Wilhelms-Universität, Münster H. Wolters MR Klinikum Lahnberge der Philipps-Universität, Marburg J. Hoyer MZ Klinikum der Johannes-Gutenberg-Universität, Mainz O. Schreiner RB Klinikum der Universität, Regensburg B. Banas RO Klinikum der Universität, Rostock O. Hakenberg ST Katharinenhospital, Stuttgart G. Hasche TU Klinikum der Eberhard-Karls-Universität, Tübingen J. Mayer UL Klinikum der Universität, Ulm M. Wittau WZ Klinikum der Julius-Maximilians-Universität, Würzburg K. Lopau

Luxembourg LX Centre Hospitalier de Luxembourg P. Duhoux

The Netherlands AV VU Medisch Centrum, Amsterdam S. Nurmohamed AW Academisch Medisch Centrum, Amsterdam F. Bemelman GR Academisch Ziekenhuis, Groningen J. Homan van der Heide LB Leids Universitair Medisch Centrum, Leiden J. de Fijter MS Academisch Ziekenhuis, Maastricht M. Christiaans NY Universitair Medisch Centrum St. Radboud, Nijmegen A. Hoitsma RD Erasmus Medisch Centrum, Rotterdam W. Weimar RS Sophia Kinderziekenhuis, Rotterdam K. Cransberg UT Universitair Medisch Centrum, Utrecht A. van Zuilen UW Wilhelmina Kinderziekenhuis, Utrecht M. Lilien

Slovenia LO University Medical Center, Ljubljana D. Kovač

Croatia OS University Hospital, Osijek J. Galić RI University Clinical Hospital, Rijeka B. Sladoje-Martinović ZA University Clinical Cospital, Zagreb J. Pasini ZM Clinical Hospital Zagreb Merkur, Zagreb M. Knotek

HEART PROGRAMS DELEGATE

Austria GA Chirurgische Universitätsklinik, Graz A. Wasler IB Chirurgische Universitätsklinik, Innsbruck G. Laufer WG Universitätsklinik für Chirurgie, Wien A. Zukermann

Belgium AN Universitair Ziekenhuis Antwerpen, Edegem I. Rodrigus AS Onze Lieve Vrouw Ziekenhuis, Aalst M. Walravens BR Université Libre de Bruxelles, Hôpital Erasme, Bruxelles M. Antoine GE Universitair Ziekenhuis, Gent F. Caes LA Cliniques Universitaires St. Luc, Bruxelles A. Poncelet LG Centre Hospitalier Universitaire, Liège J. Defraigne LM Universitair Ziekenhuis Gasthuisberg, Leuven J. Vanhaecke

7 Germany AK Universitätsklinikum der Rheinisch-Westfälischen TH, Aachen A. Moza BA Herz- & Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen G. Tenderich BD Deutsches Herzzentrum, Berlin C. Knosalla BH Kerckhoff Klinik M. Richter DR Universitätsklinikum Carl Gustav Carus, Dresden S. Tugtekin ER Med. Einrichtungen der Universität Erlangen-Nürnberg R. Tandler ES Universitätsklinikum, Essen M. Kamler FD FM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt M. Scherer FR Klinikum der Albert-Ludwigs-Universität, Freiburg F. Beyersdorf GI Klinikum der Justus-Liebig-Universität, Gießen J. Bauer GO Klinikum der Georg-August-Universität, Göttingen J. Schmitto HB Klinikum der Ruprecht-Karls-Universität, Heidelberg F.-U. Sack HG Universitäts-Krankenhaus Eppendorf, Hamburg F. Wagner HO Klinikum der Medizinischen Hochschule, Hannover A. Simon HS Klinikum der Universität des Saarlandes, Homburg-Saar F. Langer JE Klinikum der Friedrich-Schiller-Universität, Jena J. Gummert KI Klinikum der Christian-Albrechts-Universität, Kiel KL Klinik der Universität Köln-Lindenthal, Köln Th. Wittwer LP Klinikum der Universität, Leipzig H. Bittner MD Deutsches Herzzentrum, München ML Klinikum Großhadern der Ludwig-Maximilians-Universität, München B. Meiser MN Klinikum der Westfälischen Wilhelms-Universität, Münster S. Klotz MZ Klinikum der Johannes-Gutenberg-Universität, Mainz U. Mehlhorn RB Klinikum der Universität, Regensburg S. Hirt

The Netherlands GR Academisch Ziekenhuis, Groningen J. Brügemann RD Erasmus Medisch Centrum, Rotterdam A. Maat UT Universitair Medisch Centrum, Utrecht N. de Jonge

Slovenia LO University Medical Center, Ljubljana R. Blumauer

Croatia ZA University clinical hospital, Zagreb D. Milicic ZD Clinical Hospital Dubrava, Zagreb J. Sikić

LUNG PROGRAMS DELEGATE

Austria IB Chirurgische Universitätsklinik, Innsbruck G. Laufer WG Universitätsklinik für Chirurgie, Wien A. Zuckermann

Belgium AN Universitair Ziekenhuis Antwerpen, Edegem P. Van Schil BR ULB, Hôpital Erasme, Bruxelles M. Estenne LA Cliniques Universitaires St. Luc, Bruxelles P. Evrard LM Universitair Ziekenhuis Gasthuisberg, Leuven D. Van Raemdonck

Germany BD Deutsches Herzzentrum, Berlin C. Knosalla DR Universitätsklinikum Carl Gustav Carus, Dresden S. Tugtekin ES Universitätsklinikum, Essen M. Kamler FM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt M. Scherer FR Klinikum der Albert-Ludwigs-Universität, Freiburg A. Kirschbaum GI Klinikum der Justus-Liebig-Universität, Gießen R. Schulz HG Universitäts-Krankenhaus Eppendorf, Hamburg F. Wagner

8 HO Klinikum der Medizinischen Hochschule, Hannover A. Simon HS Klinikum Universität des Saarlandes, Homburg/Saar F. Langer JE Klinikum der Friedrich-Schiller-Universität, Jena J. Gummert KI Klinikum der Christian-Albrechts-Universität, Kiel LP Klinikum der Universität, Leizpig H. Bittner ML Klinikum Großhadern der Ludwig-Maximilians-Universität, München B. Meiser MN Klinikum der Westfälischen Wilhelms-Universität, Münster S. Klotz MZ Klinikum der Johannes-Gutenberg-Universität, Mainz M. Dahm

The Netherlands GR Academisch Ziekenhuis, Groningen M. Erasmus RD Erasmus Medisch Centrum, Rotterdam J. Bekkers UT Universitair Medisch Centrum, Utrecht E. van de Graaf

LIVER PROGRAMS DELEGATE

Austria GA Chirurgische Universitätsklinik, Graz F. Iberer IB Chirurgische Universitätsklinik, Innsbruck W. Mark WG Universitätsklinik für Chirurgie, Wien R. Steininger

Belgium AN Universitair Ziekenhuis Antwerpen, Edegem D. Ysebaert BR ULB, Hôpital Erasme, Bruxelles V. Donckier GE Universitair Ziekenhuis, Gent X. Rogiers LA Cliniques Universitaires St. Luc, Bruxelles J. Lerut LG Centre Hospitalier Universitaire, Liège O. Detry LM Universitair Ziekenhuis Gasthuisberg, Leuven J. Pirenne

Germany BC Charité-Campus Virchow Klinikum der Humboldt Universität, Berlin J. Pratschke BO Chirurgische Universitätsklinik, Bonn N. Speidel ER Chirurgische Klinik der Universität Erlangen-Nürnberg, Erlangen V. Müller ES Universitätsklinikum, Essen A. Paul FM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt C. Mönch GO Klinikum der Georg-August-Universität, Göttingen A. Obed HB Klinikum der Ruprecht-Karls-Universität, Heidelberg J. Schmidt HG Universitäts-Krankenhaus Eppendorf, Hamburg L. Fischer HO Klinikum der Medizinischen Hochschule, Hannover Th. Becker HS Klinikum Universität des Saarlandes, Homburg/Saar O. Kollmar JE Friedrich Schiller Universität, Jena U. Settmacher KI Klinikum der Christian-Albrechts-Universität, Kiel F. Braun KL Klinik der Universität Köln-Lindenthal D. Stippel KM Städtische Krankenanstalten Köln-Merheim, Köln D. Stippel LP Klinikum der Universität, Leipzig S. Jonas MB Klinikum Otto-von-Guericke Universität, Magdeburg H. Lippert MH Klinikum Rechts der Isar der Technischen Universität, München M. Stangl ML Klinikum Großhadern der Ludwig-Maximilians-Universität, München K-W. Jauch MN Klinikum der Westfälischen Wilhelms-Universität, Münster H. Wolters MZ Klinikum der Johannes-Gutenberg-Universität, Mainz M. Heise RB Klinikum der Universität, Regensburg M. Scherer RO Klinikum der Universität, Rostock E. Klar TU Klinikum der Eberhard-Karls Universität, Tübingen S. Nadalin WZ Klinikum der Julius-Maximilians-Universität, Würzburg U. Steger

The Netherlands GR Academisch Ziekenhuis, Groningen R. Porte LB Leids Universitair Medisch Centrum, Leiden J. Ringers RD Erasmus Medisch Centrum, Rotterdam H. Tilanus

9 Slovenia LO University Medical Centre, Ljubljana S. Markovič

Croatia RI University Clinical Hospital, Rijeka ZA University Clinical Hospital, Zagreb O. Deban ZP University Clinical Hospital Pediatric, Zagreb B. Kocman ZM Clinical Hospital Merkur, Zagreb

PANCREAS (ISLET) PROGRAMS DELEGATE

Austria GA Chirurgische Universitätsklinik, Graz F. Iberer IB Chirurgische Universitätsklinik, Innsbruck W. Mark WG Universitätsklinik für Chirurgie, Wien F. Mühlbacher

Belgium AN Universitair Ziekenhuis Antwerpen, Edegem D. Ysebaert BR ULB, Hôpital Erasme, Bruxelles A. Hoang GE Universitair Ziekenhuis, Gent C. Randon LA Cliniques Universitaires St. Luc, Bruxelles L. De Pauw LG Centre Hospitalier Universitaire, Liège A. Deroover LM Universitair Ziekenhuis Gasthuisberg, Leuven W. Coosemans BP Academisch Ziekenhuis der Vrije Universiteit, Brussel D. Pipeleers

Germany BB Knappschaftskrankenhaus, Bochum R. Viebahn BC Charité-Campus Virchow Klinikum der Humboldt Universität, Berlin A. Kahl BO Chirurgische Universitätsklinik, Bonn ER Chirurgische Klinik der Universität Erlangen-Nürnberg, Erlangen V. Müller ES Universitätsklinikum, Essen A. Paul FM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt C. Mönch FR Klinikum der Albert-Ludwigs-Universität, Freiburg P. Pisarski GI Klinikum der Justus-Liebig-Universität, Gießen D. Winter HB Klinikum der Ruprecht-Karls-Universität, Heidelberg HO Klinikum der Medizinischen Hochschule, Hannover Th. Becker JE Friedrich Schiller Universität, Jena U. Settmacher KI Klinikum der Christian-Albrechts-Universität, Kiel F. Braun KL Klinik der Universität Köln-Lindenthal D. Stippel KM Städtische Krankenanstalten Köln-Merheim, Köln D. Stippel LP Klinikum der Universität, Leipzig D. Uhlmann LU Klinikum der Medizinischen Universität, Lübeck MH Klinikum Rechts der Isar der Technischen Universität, München M. Stangl ML Klinikum Großhadern der Ludwig-Maximilians-Universität, München H. Arbogast MN Klinikum der Westfälischen Wilhelms-Universität, Münster H. Wolters MR Klinikum Lahnberge der Philipps-Universität, Marburg RB Klinikum der Universität, Regensburg S. Farkas RO Klinikum der Universität, Rostock E. Klar TU Klinikum der Eberhard-Karls-Universität, Tübingen S. Nadalin

The Netherlands GR Academisch Ziekenhuis, Groningen R. Ploeg LB Leids Universitair Medisch Centrum, Leiden J. Ringers

Croatia ZM Clinical Hospital Merkur, Zagreb S. Jadrijević

10 Tissue typing laboratories DELEGATE

Austria GA Universitätsklinik, Abteilung für Transfusionsmedizin und Immunohämatologie, Graz U. Posch IB Universitätsklinik, HLA Labor, Innsbruck A. Mühlbacher OL Allgemeines Krankenhaus, Blutzentrale, Linz C. Gabriel OW Allgemeines Krankenhaus, HLA Labor, Wels R. Loizenbauer WG Institut für Blutgruppenserologie, Wien W. Mayr

Belgium AN Bloedtransfusiecentrum Antwerpen, Belgische Rode Kruis, Edegem* A. Vanhonsebrouck BJ Academisch Ziekenhuis der Vrije Universiteit, Bloedtransfusiecentrum Jette, Brussel C. Demanet BR Hôpital Erasme, Tissue typing laboratory, Bruxelles M. Andrien GE Universitair Ziekenhuis, Tissue typing laboratory, Gent* I. Van Haute LA Université de Louvain, Tissue typing laboratory, Bruxelles D. Latinne LG Laboratoire des Groupes Sanguins, Liège G. Maggipinto LM Bloedtransfusiecentrum, Belgische Rode Kruis, Leuven* M.-P. Emonds * Rode Kruis Vlaanderen, Laboratory for Histocompatibility & Immunogenetics (HILA), Mechelen

Germany BC Charité-Campus Virchow Klinikum der Humboldt Universität, Berlin C. Schönemann BE Universitätsklinikum Benjamin Franklin, Labor für Gewebetypisierung, Berlin I. Blau DU Institut für Transplantationsdiagnostik und Zelltherapeutika, Düsseldorf J. Rox ER Institut für Klinische Immunologie, Erlangen B. Spriewald ES Universitätsklinikum, Institut für Immunologie, Essen F. Heinemann FM Immunohaematologie, Blutspendedienst Hessen, Frankfurt C. Seidl FR Blutspendedienst, Labor für Gewebetypisierung, Freiburg C. Schulz-Huotori GI Institut für Klinische Immunologie und Transfusionsmedizin, Gießen S. Wienzek GO Klinikum der Universität, HLA Labor, Göttingen H. Neumeyer HA Institut für Phathologische Biochemie, Interdisziplinäres Typisierungslabor, Halle W. Altermann HB Institut für Immunologie und Serologie, Heidelberg S. Scherer HG Universitäts-Krankenhaus Eppendorf, HLA Labor, Hamburg T. Binder HO Klinikum der Medizinischen Hochschule, Immunohaematologie/Blutbank, Hannover M. Hallensleben KI Klinikum der Christian-Albrechts-Universität, HLA Labor, Kiel M. Marget KM Institut für Transfusionsmedizin, Köln-Merheim U. Bauerfeind KS Institut für Rechtsmedizin, Transplantationsimmunologie, Kaiserslautern B. Thiele LU Institut für Immunologie und Transfusionsmedizin, Lübeck M. Ziemann ML Kinderklinik der Ludwig-Maximilians-Universität, HLA Labor, München M. Spannagl MZ Klinikum der Johannes-Gutenberg Universität, HLA Labor, Mainz W. Hitzler RO Klinikum der Universität, Abteilung für Transfusionsmedizin, HLA Labor, Rostock TU Klinikum der Eberhard-Karls-Universität, Abt. für Transfusionswesen und Blutbank, Tübingen E. Fehrenbach UL DRK Blutspendezentrale, Transplantationsimmunologie, Ulm J. Mytilineos

Luxembourg LX Centre Hospitalier, HLA Lab, Luxembourg F. Hentges

The Netherlands AW Centraal Laboratorium Bloedtransfusiedienst, Nederlandse Rode Kruis, Amsterdam N. Lardy GR Laboratorium voor transplantatie-immunologie, Groningen S. Lems LB Leiden University Medical Centre, Immunohaematologie, Leiden F. Claas MS Academisch Ziekenhuis, Laboratorium voor weefseltypering, Maastricht M. Tilanus NY Academisch Ziekenhuis St. Radboud, Bloedtransfusiedienst, Nijmegen W. Allebes UT Academisch Ziekenhuis, Bloedbank, Utrecht H. Otten

Slovenia LO Tissue Typing Centre, Blood Transfusion Centre, Ljubljana B. Vidan-Jeras

Croatia ZA University clinical hospital, Zagreb R. Zunec

ETRL Eurotransplant Reference Laboratory, Leids Universitair Medisch Centrum, Leiden, The Netherlands F. Claas, I. Doxiadis

11 12 Foreword

We hereby present to you the Annual Report 2008 of the Eurotransplant International Foundation. The objective of this report is to be accountable for the activities and initiatives that were undertaken in 2008 in Austria, Belgium, Croatia, Germany, Luxembourg, the Netherlands and Slovenia towards the internal and external parties with a vested interest in the Foundation such as: • the national regulating transplant authorities; • the national representatives of the transplant societies; • the financing authorities; • the donor hospitals; • the transplant centers; • the tissue typing laboratories; • the employees of the Leiden office.

As always, many people have worked systematically to achieve our mission to encourage organ transplantation and to reach the goals associated with it. Obviously, excellent work was done by doctors and nurses of the donor hospitals and by the transplant centers, the tissue typers, the transplant coordinators and by many others like the people working at the Leiden office. Our organ Advisory Committee members put a lot of time and effort in setting organ allocation standards. To reach the goals stated in our mission, Eurotransplant manages its three core processes: state of the art organ allocation, algorithm development and data registry.

Many milestones have been reached during the year 2008: the 25th anniversary of the Eurotransplant winter meeting, the meeting of high officials from the health care ministries of the seven Eurotransplant countries(EuTIEP), the visit of the EU Health Commissioner to Eurotransplant, the ET Policy Planning Project (ETP) involving among others the financial authorities of the Eurotransplant member states, the annual meeting, the approval by the European Commission to become Eurotransplant project leader of the EFRETOS project and finally the EFI accreditation of the tissue typing laboratory in Rijeka, the second competent laboratory in Croatia.

Detailed reports and descriptions of all above mentioned milestones will be given in the following chapters of this Annual Report.

However, there is one event to which we want to pay special attention in this foreword: the Eurotransplant Past-President, Prof. Yves Vanrenterghem, resigned from the Board after having served Eurotransplant for many years in a very dedicated way as a Board member and as President. In order to thank him for all his efforts and achievements, the Eurotransplant Board appointed him as Honorary President of the Eurotransplant International Foundation. In addition, Prof. Yves Vanrenterghem was awarded a Belgian royal decoration - Ridder in de Leopoldsorde – during the annual Presidential Symposium.

Finally, we hope – with support from all you – to realize as many as possible challenging achievements in the year 2009!

PD Dr. Bruno Meiser Dr. Axel Rahmel Dr. Arie Oosterlee MBA President Medical Director General Director

Leiden, May 2009

13 1. Report of the Board and the central office of Stichting Eurotransplant International Foundation

V.C. Diepeveen-Huijsman, R. Cranendonk and A. Oosterlee, Eurotransplant International Foundation, the Netherlands

The Board of Stichting Eurotransplant International Foundation met on January 23, May 19 and October 8 & 10, 2008. Four Board members A were re-elected by the Assembly. Prof.Dr. Ferdinand Mühlbacher and Prof.Dr. Dirk Ysebaert were re- elected as members A in the kidney section. Prof.Dr. Karl-Walter Jauch and Prof.Dr. Dirk Van Raemdonck were re-elected in the liver and thoracic (lung) sections respectively. The Assembly re-elected Prof.Dr. Günther Laufer as chairman of the Assembly.

1.1 General During its first 2008 meeting, the Board discussed the follow-up of the round table conference with health care ministers of the ET countries that took place in the year 2007. In order to meet the agreements that resulted from the ministers’ conference, the Board decided to organize a meeting on the level of high officials of health care ministries during which the establishment of a platform for exchange of information as well as the establishment of a post-transplant registry were to be discussed. The first meeting of this ET Exchange Information Platform (EuTIEP) took place in June 2008. The EuTIEP consists, besides the ministerial representatives, of the ET directors and the national representatives in the ET Board. Current practices and problems with respect to organ donation were topics of discussion. With regard to the establishment of an ET post-transplant data registry, a number of questions were raised by the EuTIEP members such as who is collecting the data, who is financing the service, who is owner of the data, etc. Finally, the EuTIEP achieved consensus on the necessity that ET is the organization to set up such a registry.

The Board was informed about several expert meetings that took place in the recent past on the subject of organ donation and transplantation within the EU. Some of these meetings dealt with basic issues whereas others had a more political character. During one of these expert meetings, the president and the general director had a meeting with some members of the European Parliament in which regulations regarding organ donation and allocation were addressed. The general opinion in the Board was that ET should do its utmost to avoid that the EU imposes too strict rules leading to over-regulation.

The directors informed the Board that he European Commission (EC) issued calls for proposals in order to stimulate organ transplantation projects aiming at improving quality and safety, increasing organ availability and making transplantation systems more efficient and accessible. One of the call for proposals concerned:evaluation of post-transplant results on organ transplantation. In order to obtain widespread international recognition of ET, the directors were very interested to answer this specific call for proposal.

After careful considerations and having found coalition partners, the ET directors successfully tried to participate in this international effort as project leader. The project, called European FRamework for Evaluation of Transplant OrganS (EFRETOS), was accepted by the EC and was financially supported. The coalition partners in this project were CNT (Italy), ONT (Spain), Scandiatransplant, UK Transplant and ESOT. The Dutch Transplant Foundation (NTS), Deutsche Stiftung Organ-transplantation (DSO) and Slovenija Transplant were also involved in this project.

The Board congratulated the directors with this accomplishment since this project was considered to be very important due to its scientific impact and also from a political point of view. It is regarded as another step in establishing ET as a leading organization and in consolidating its future position.

The Board was pleased that EU Commissioner Mrs. Androulla Vassiliou visited the ET office where she was welcomed by the president and the directors. She was very supportive towards the EuTIEP as well as to the coordination by ET of the EFRETOS project.

14 In the beginning of 2008, ET was still in a negative financial position although the year 2007 was fortunately ended with less deficit than expected. However, measures had been taken which enabled the provision of a balanced budget for the year 2008. Positive negotiations with health insurance companies (KK) took place which resulted in an increase in the annual budget and an offer by the KK to financially support the development of a strategic plan for the mid-term (5 years) and its consequences. This plan should address the development of ET’s services, an appropriate organizational structure and functions, the desired reserve and cash flow position as well as benchmarking with similar organizations. This initiative was to be supported by an external consulting company.

The Financial Committee recommended the Board, due to the financial situation and the decreased reserve position, to carefully consider starting new projects that were not included in the budget. This recommendation was accepted by the Board.

The directors informed the Board about ET’s financial situation through quarterly overviews. The expection to end the year with a slight positive result was realized.

The Board approved two recommendations in relation to finance one of which was the ET budget proposal 2009. The other one was related to a report by an external agency, Lokerse Consultancy. This agency worked together with the directors on ET’s policy planning project (2009-2013) [ETP]. The Board gave the directors a mandate to use the current and future results of the Lokerse report in the budget negotiations with the German health care insurance companies.

The Board was elaborately informed about the progress of the ETP. For the first phase of the project, Lokerse Consultancy achieved three milestones. First of all, they determined the current situation of ET, the Ist-situation. Secondly, a risk analysis was performed. Finally they developed a proposal for a new financial model, which could be used for budget negotiations.

A number of conclusions were drawn from the Lokerse report: 1. ET country specific services mandated by national authorities should be made more transparent. 2. ET is vulnerable because knowledge in some key areas is limited to only one or few experts. 3. Establishment of a central communication function is strongly recommended. 4. ET is underfunded in some areas; 5. In order to improve the organization, Lokerse recommended to add personnel for project management, communication & registry and support of the directors. In addition it was recommended to raise funds for the allocation department, development of the IT department, housing and maintenance and the development of a budget for training and education of ET personnel.

The discussion on the ETP was concluded by the decision to form a task force consisting of the president, some Board members and the directors to develop recommendations for improving the internal organization based on the Lokerse report and develop recommendations for ET’s future strategy.

The ET non-resident working group, established by the ET Board, presented a proposal for a non-resident policy in ET. The proposed policy contained two important changes in comparison to the current non-resident rules. One of them is to distinguish the following types of patients for registration in ENIS: • national residents • non-national ET residents; • non-national residents outside ET but within the EU; • all other residents. This proposal was accepted by the Board.

The second important change concerned the proposal that the 5% rule [the number of non-resident registrations for patients (either first or repeat) for a thoracic or liver (re)transplant should not exceed 5% of the total number of transplantations (either first or repeat) by this center in the preceding year], should become applicable for all organs, also kidney and pancreas, which organs are currently excluded. There was no consensus in the Board regarding the proposal of the working group to extend the 5% rule also to non-resident kidney and pancreas patients. The Board therefore decided that this proposal was first to be discussed by the ETKAC. The ETKAC concluded for several reasons not to be in favor of extending the 5% rule to kidney patients. Based on this conclusion, the Board finally approved the ET non-resident policy with maintenance of the 0% rule for kidney and pancreas which implies that non-resident kidney and pancreas patients cannot be registered on the ET waiting list.

With regard to requests from non-ET countries to register patients in need of combined organs (e.g. heart+kidney), the Board stated that in case of listing for a combined transplantation, the leading organ has to fit into the 5% non-resident rule and therefore, in case of a combined transplant request, a non-resident kidney patient can be accepted.

15 The Board approved the final version of the general conditions. The general conditions, which will be applicable for all hospitals cooperating with ET, will be published on the ET website. Approval of the general conditions by all ET national authorities is still pending for which reason they cannot yet be implemented. The reason that some national authorities did not yet approve the general conditions is related to some national laws that prohibit limitation of liability. Active approval rather than silent approval might strengthen the legal position of the general conditions. From this point of view, it was decided to address this issue during the meeting of the ET Information Exchange Platform (EuTIEP) meeting as an attempt to convince national authorities. Obtaining approval from all national societies by December 31, 2008 was aimed at.

The Board agreed upon a new concept of the ET winter meeting. A small working group consisting of two Board members and the directors were given a mandate to further explore the possibilities. There is no doubt that also thanks to the kind hospitality of the Erlebach family, 25 successful ET winter meetings have taken place in Hotel Waldfriede in Fügen. However, the Board supported the opinion of the working group that a new venue better fits into a new concept than staying in Fügen. It was therefore decided to organize the ET winter meeting in ALPBACH, Austria from January 22 – January 24, 2009.

During the May 2008 Board meeting, the Croatian observer, Dr. Mirela Bušić, was welcomed as an official member in the Board. The Board was furthermore informed that the tissue typing laboratory in Reijka, Croatia had obtained its accreditation by the European Federation of Immunogenetics (EFI).

The Board was informed about the progress of electronic donor data exchange. Except for one country, all ET countries send their donor data electronically. This is considered to be an important step in improving the quality of the allocation process since it eliminates the risk of human error in the transscription of donor data.

The Board was informed about negotiations aiming at hosting of a Ventricular Assist Devices (VAD) Registry of the International Society for Heart Lung Transplantation (ISHLT) by ET. The beneficial effect of hosting such a registry would be further recognition of ET’s registry function and increased services to the thoracic transplant centers in ET. During the year 2008 negotiations between ET and ISHLT took place. The ET directors had offered ISHLT to host the registry as well as producing standard reports and some basic data management services. It was emphasized that for the time being ET would not be able to provide more services – such as data collection - due to the fact that it was already involved in many other projects.

However, the current global financial crisis made the ISHLT decide not to initiate any new projects for the time being. This means that setting up the VAD registry project was postponed.

The Past-President of ET, Prof. Yves Vanrenterghem, who served ET for many years in a very dedicated way as a Board member and as President was appointed as Honorary President of the Eurotransplant International Foundation. Furthermore, Prof. Yves Vanrenterghem was awarded a Belgian royal decoration - Ridder in de Leopoldsorde – during the annual Presidential Symposium.

The Board said goodby to the first Slovenian representative in the Board, Dr. Jasna Vončina. Ms. Ellen Houwaart was welcomed as the new secretary of the Board in succession to Ms. Verena Diepeveen. Mr. Ton Valkering was welcomed as the new manager Finance/IT.

The director of the Vienna lung transplant program and the Board discussed the lung transplant cooperation between Vienna and several non-ET countries. It was agreed upon that there are no objections against these cooperations as long as they comply with the ET twinning agreement standards and the 5% non-resident rule is adhered to.

The Board approved the renewal of a liver twinning agreement between Vienna and Bratislava.

A renewed agreement between ET and NTS was signed on October 9, 2008. The Board was informed that the renewed agreement covers the same tasks as the previous agreement. However, several matters have been described more specifically as well as explicitly.

The Board discussed the progress on implementation of already approved recommendations and expressed some concern about the rather long timeframe between approval and implementation. The directors explained the required amount of man- hours (IT as well as medical administration and staff) leading to prolonged implementation times but also informed that thanks to the introduction of new technologies the implementation of recommendations is expected to be sped up in the future.

16 The implementation of some recommendations has a high (IT) impact while they only concern a few cases per year. In order to achieve economies of scale, the Board suggested the directors that implementation of such recommendations should be combined with other ENIS adaptations.

In view of the fact that sometimes donor information changes during the allocation procedure, the issue of the role of donor profiles in allocation and inconsistencies in donor profiles was discussed by the Board. The Board was unanimously of the opinion that ‘an offer is an offer’ and formulated a recommendation that covers this statement (RET01.08). With regard to different profiles of patients listed for combined organ transplantation, the Board decided that the profile of the ‘leading organ’ will be used. Leading organ can be explained by the sequence in which organs are offered: Lung->Heart->Liver-> Pancreas->Intestine->Kidney.

The selection committee of the Henk Schippers Young Investigators Award informs the Board that this year two applicants gained the same score. This resulted in two winners who shared the prize: Dr. Cyril Moers from the University Hospital, Groningen, the Netherlands and Dr. Fleur Samantha Benghiat from the Institute for Medical Immunology, Brussels, Belgium.

The directors provided the Board with a proposal for rules regarding data access and publication of ET presentations on the ET website. In the proposed rules regarding data access several groups of users are to be distinguished and for each group the accessibility level to data is described: patient, center and country level. The proposed regulations for data presentation on the ET website are based on the proposed rules regarding data access. The Board approved the rules as proposed by the ET directors. It is expected that putting these data on the public site will reduce the number of external requests and as a consequence reduce the workload for ET.

The Board was furthermore presented with a proposal for a practical approach to prioritization and authorization concerning data analysis. This approach is based on a categorization of requests in three levels indicating the workload involved, the inquirers relation to ET and the expected period of time in which data requests will be dealt with. The Board postponed a decision on the approach document until after having received a cost calculation per level.

1.2 Policy The Board discussions, among other issues, concentrated on the proposed recommendations by the various Advisory Committees. Obviously, the work done in these committees contributes to improve the core of the business, namely: state of the art allocation. The Board is grateful for all the time and efforts the Committee members have provided to this important part of the work of Eurotransplant. A complete list of all recommendations approved in 2008 is published under section 1.5 of this chapter.

17 Joint Declaration on cooperation within the framework of Eurotransplant International Foundation The Minister of Social Affairs and Public Health of the Kingdom of Belgium,

The Minister of Health and Social Welfare of the Republic of Croatia,

The Federal Minister of Health of the Federal Republic of Germany,

The Minister of Health and Social Security of the Grand Duchy Luxembourg,

The Minister of Health, Welfare and Sport of the Kingdom of the Netherlands,

The Federal Minister of Health, Family and Youth of the Republic of Austria and The Minister of Health of the Republic of Slovenija,

issue the following Joint Declaration on cooperation within the framework of Eurotransplant International Foundation:

We, Ministers of Health, wish to express our recognition of the activities performed by the Eurotransplant International Foundation (ETI) in Leiden, the Netherlands.

We are of the opinion that the subjects addressed in the Joint Declaration of November 2000 are today undiminished valid.

We emphasize: • that the importance of international cooperation on organ transplantation within the Eurotransplant International Foundation framework has been demonstrated and should be continued; • the necessity and added value of a fruitful cooperation between the professionals and the national authorities within the framework of Eurotransplant as opposed to separate agreements; • that it is of crucial importance for the acceptance of transplantation medicine in the participating countries and in the interest of the patients that distribution of the allocated donor organs is performed as fairly as possible within a transparent and objective allocation system according to medical criteria; • the necessity of having systems operational for quality and safety in the area of organ donation. The state of a donor organ eligible to be allocated by Eurotransplant International Foundation must comply with those safety and quality requirements that are or might be imposed in accordance with the most recent advancements in medical science. • our involvement as Ministers of Health with Eurotransplant International Foundation, its transparent and unambiguous allocation system and the responsibility of Eurotransplant International Foundation towards the participating member states.

Given the above considerations and the need to take into account national regulatory frameworks as well as efforts directed at the implementation of appropriate measures to improve the existing opportunities for post-mortem organ donation, we, Ministers of Health

• agree that the mutual exchange of practices in the area of post-mortem organ donation between the Eurotransplant International Foundation member states is valuable and supported by us; • agree that Eurotransplant International Foundation fulfils an important role as a platform for the exchange of knowledge and practices; • encourage the realization of a collection system for transplant results within Eurotransplant International Foundation.

This declaration was signed on September 24, 2007 in Valkenburg aan de Geul, the Netherlands:

on behalf of the Minister of Social Affairs and Public Health of the Kingdom of Belgium, President of the Board of Directors of the Federal Public Service Health, Food Chain, Safety and Environment Dr. Dirk Cuypers The Minister of Health and Social Welfare of the Republic of Croatia, Prof. Dr. Neven Ljubičić The Federal Minister of Health of the Federal Republic of Germany, Mrs. Ulla Schmidt The Minister of Health and Social Security of the Grand Duchy of Luxembourg, Mr. Mars di Bartolomeo The Minister of Health, Welfare and Sport of the Kingdom of the Netherlands, Dr. Ab Klink Vienna, The Federal Minister of Health, Family and Youth of the Republic of Austria, Dr. Andrea Kdolsky The Minister of Health of the Republic of Slovenija, Mrs. Zofija MazejKukovič

18 1.3 Quality Assurance & Safety

In 2007 a solid base was founded for further development of the quality assurance system in 2008 which included: • A detailed analysis of specific parts of the allocation process that ETI intends to automate in order to further reduce the risk of human error. This analysis was the input for a new project to redesign some parts of the process. • Several presentations were given for the allocation department on the subject of management of patient safety. This was the logical step after completion of the detailed analysis of the process. • The completion of the project for implementing an incident reporting system resulted in a significant increase of the employees’ awareness for patient safety. • Responsibility for the maintenance of the quality manual was distributed and specifically assigned to several employees of the department of allocation itself. This was made possible by implementing an information management system. The annual visit of the Prüfungskommission of the German Bundesärztekammer and the annual ISO 9001 audit by Veritas were also part of further development of the quality assurance system.

Safety management and patient safety Safety management covers different area’s, such as patient safety, minimization of liability risks and financial safety. ET services countries with different law systems and different rules.

In the automated matching process all these country-specific laws and rules are taken into account. The ET Manual gives a transparent outline per organ of all rules and criteria. However there remain several processes that must be managed in order to achieve a system that complies with all national regulations and that enhances the patient safety, i.e. the safety of the recipient. These variables are among others the limited available time for allocation of organs and the reporting of several donors at the same time.

As stated in our report of 2007, the culture underlying attitudes and commitments regarding patient safety within the organization, are key to instituting and sustaining meaningful improvements. For this reason the implementation of an incident reporting system for improving the patient safety as well as the risk awareness of the employees in the allocation department was started. In October 2008 the implementation was completed.

Annual audit in accordance with ISO 9001:2000 We can state that the implementation of an information system for the Quality Assurance Manual and assigning responsibility to employees for specific processes was a success. This was acknowledged by the lead auditor of Veritas. Although certification according to ISO 9001:2000 is valid for another 2 years, ET has already made a start for certification according to ISO 9001:2008, in which more emphasis is put on risk assessment.

Annual visit of the Prüfungskommission of the German Bundesärztekammer The representatives of the Prüfungskommission extensively audited the allocation process. They did not identify deviations in the execution of procedures. Although documentation was regarded to be complete it was advised to keep files per donor together. With the implementation of a new software system before January 2010, part of the paper documentation will be replaced by electronic documentation.

Internal audits Three employees were trained by an external institute for internal auditing. After completion of the training they did an internal audit on the whole management system in both the allocation department and the IT-department. The results were satisfactory and the management decided that there was room for a theme audit in 2009.

Complaints and incidents The pilot project for the registration and evaluation of incidents, which was started in 2007, was completed in October 2008. Based on the experiences acquired in this project ET decided to install a central incidents committee for all departments and to continue the incidents committee for the allocation department.

An incident is defined as anything that can possibly lead to a disruption of the allocation process, i.e. incidents vary for example from a defective fax to administrative mistakes.

Reported near-incidents and incidents With an 2008 2007 2006 2005 Internal cause 287 293 161 128 External cause 236 263 98 117 Internal & External cause 17 24 13 Total 540 580 271 245

19 The number of reported incidents seems to stabilize. Almost all of the incidents with an internal cause were incidents in incomplete administration, which led to extra administrative operations such as re-examining the donor log. As far as incidents with an external cause were concerned, incidentally advice was given to transplant coordinators and transport companies.

Since October 1, an email address ([email protected]) for complaints and suggestions has been put on the membersite with an explanation of our new complaints handling procedure. So far only one email, not concerning a complaint, was received on this address.

Quality Performance Indicators (QPI’s) The Infrastructure section of the IT department has gained experience with QPI’s as a means to improve processes. The co- ordinator of this department quarterly reports to the director. The results from the Infrastructure section concern:

A. User Accounts The top 3 of problems were: • user locked out ( 20%); • forgotten password (13%); • insufficient rights (13%).

B. Availabilty of ENIS In 2008 ENIS was down for 26 minutes to implement 2 new releases, and it was down for 13 minutes as a result of a power failure. The availability of the system was 99,990%

C. Report on the contingency procedure The contingency procedure is tested annually. This test includes testing of the back-up power unit, the back-up procedures for communication devices, internet, ENIS, firewall etc. in the event of power failure, computer failure etc.

The test in 2008 had satisfactory results. The main systems and software (ENIS, Firewall, Internet) were online within the defined timeframes. There were a few marginal problems resulting in a few small adjustments in the procedures.

The systems development department was the next department to create reliable indicators. The first results will be discussed in the first trimester of 2009.

1.4 Advisory Committees

Eurotransplant positions itself as an independent scientifically oriented organization. Various organ Advisory Committees, of which the chairmen hold a position in the Board of Eurotransplant, meet several times a year and discuss the impact of new scientific developments in the field of organ allocation, organ procurement as well as transplant ethics. Their conclusions are proposed as recommendations to the Board of Eurotransplant. In the respective member states National Transplant Authorities authorize recommendations approved by the Board of Eurotransplant, sometimes with slight adaptations to the national circumstances.

Through this practice transplant regulations throughout Eurotransplant have a great degree of uniformity. All recommendations approved by the Board of Eurotransplant are listed in chapter 1.5.

In 2008, the various Advisory Committees met 18 times and submitted 18 recommendations, 17 of which were approved and 1 of which was postponed.

The composition of the various Advisory Committees as per December 31, 2008 was as follows:

KIDNEY ADVISORY COMMITTEE (ETKAC)

Name As of Remarks Prof.Dr. J. de Fijter, Leiden 01.2005 chairman, representative Board Prof.Dr. F. Mühlbacher, Vienna 09.1994 representative Austria Prof.Dr. A. Rosenkranz 01.2008 representative Austria Dr. P. Duhoux, Luxembourg 09.1994 representative Luxembourg Dr. K. Wissing, Brussels (BR) 01.2004 representative Belgium Dr. P. Peeters, Gent 02.2006 representative Belgium

20 Prof.Dr. U. Heemann, Munich 01.2002 representative Germany Prof.Dr. U. Kunzendorf, Kiel 01.2002 representative Germany Prof.Dr. B. Krämer, Bochum 01.2006 representative Germany Prof.Dr. P. Fornara, Halle 11.2006 representative Germany Dr. J. Homan van der Heide, Groningen 04.2005 representative the Netherlands Dr. L. Hilbrands, Nijmegen 01.2006 representative the Netherlands Dr. M. Arnol, Ljubljana 01.2006 representative Slovenia Prof.Dr. J. Pasini, Zagreb 04.2008 representative Croatia Prof.Dr. F.H.J. Claas, Leiden (ETRL) 09.1994 representative TT Assembly Dr. J. de Boer, Eurotransplant 12.2005 secretary

LIVER INTESTINE ADVISORY COMMITTEE (ELIAC)

Name As of Remarks Prof.Dr. R. Rogiers, Gent 09.2007 chairman, representative Board Prof.Dr. R. Steininger, Vienna 11.2004 representative Austria Dr. O. Detry, Liège 01.2000 representative Belgium Prof.Dr. P. Michielsen, Antwerp 01.2008 representative Belgium Prof.Dr. P. Neuhaus, Berlin 09.1994 representative Germany Prof.Dr.N. Senninger, Münster 01.2004 representative Germany Prof.Dr. G. Otto, Mainz 01.2008 representative Germany Prof.Dr. R. Porte, Groningen 01.2006 representative the Netherlands Dr. V. Sojar, Ljubljana 01.2008 representative Slovenia Dr. B. Kocman, Zagreb 04.2008 representative Croatia Dr. A. Rahmel, Eurotransplant 02.2007 secretary a.i.

PANCREAS ADVISORY COMMITTEE (EPAC)

Name As of Remarks Prof.Dr. W. Schareck, Rostock 12.2005 chairman, representative Board Prof.Dr. P. Hengster, Innsbruck 11.2004 representative Austria Prof.Dr. C. Mathieu, Leuven 02.2006 representative Belgium Prof.Dr. R.G. Bretzel, Giessen 09.1996 representative Germany Prof.Dr. R. Viebahn, Bochum 11.2004 representative Germany Dr. A. Kahl, Berlin 01.2006 representative Germany Dr. J. Ringers, Leiden 04.1998 representative the Netherlands Dr. A. Tomazič 01.2007 representative Slovenia Dr. S. Jadrijević, Zagreb 04.2008 representative Croatia Prof.Dr. F.H.J. Claas, Leiden (ETRL) 08.1994 representative TT Assembly Dr. S. Vogelaar, Eurotransplant 07.2008 secretary

THORACIC ADVISORY COMMITTEE (EThAC)

Name As of Remarks Prof.Dr. G. Laufer, Innsbruck 10.2001 chairman, representative Board Prof.Dr. A. Wasler, Graz 11.2001 representative Austria Prof.Dr. A. Zuckermann, Vienna 01.2008 representative Austria Prof.Dr. P. Evrard, Brussels (LA) 01.2004 representative Belgium Prof.Dr. M. Depauw, Gent 01.2006 representative Belgium Dr. P. Überfuhr, Munich 02.2006 representative Germany Dr. U. Schulz, Bad Oeynhausen 05.2006 representative Germany Prof.Dr. H. Reichenspurner, Hamburg 02.2008 representative Germany Dr. H. Bittner, Leipzig 02.2008 representative Germany Dr. W. van der Bij, Groningen 06.2001 representative the Netherlands Dr. N. de Jonge, Utrecht 01.2004 representative the Netherlands Prof.Dr. I. Kneževič, Ljubljana 07.2007 representative Slovenia Prof.Dr. Z. Sutlić, Zagreb 04.2008 representative Croatia Dr. J. Smits, Eurotransplant 07.2002 secretary

21 ORGAN PROCUREMENT COMMITTEE (OPC)

Name As of Remarks Prof.Dr. D. Ysebaert, Antwerp 10.2005 chairman, representative Board Dr. H. Pokorny, Vienna 10.2007 representative TC’s Austria Ms. G. Van Beeumen, Antwerp 02.2006 representative TC’s Belgium Dr. N. Frühauf, Hanover 01.2008 representative DSO Germany Prof.Dr. E. Klar, Rostock 01.2008 representative TC’s Germany Ms. J. Hagenaars, Rotterdam 04.2008 representative TC’s NL Dr. B. Trotovšek, Ljubljana 01.2008 representative Slovenia Dr. Z. Zupan, Rijeka 04.2008 representative Croatia Prof.Dr. P. Fornara, Halle 12.2006 representative ETKAC Dr. O. Detry, Liège 01.2000 representative ELIAC Dr. J. Ringers, Leiden 04.2002 representative EPAC Prof.Dr. A. Zuckermann, Vienna 04.2008 representative EThAC Prof.Dr. I. Doxiadis, Leiden (ETRL) 02.1998 representative TTAC Dr. I. Tieken, Eurotransplant 09.2007 secretary

COMPUTER SERVICES WORKING GROUP (CSWG)

Name As of Remarks Prof.Dr. F. Mühlbacher, Vienna 09.1995 chairman, representative Board + ETKAC Dr. R. Kramar, Wels 09.1995 representative Austria Mr. D. Van Hees, Leuven 03.2004 representative Belgium Mr. M. Schenk, Tübingen 01.2008 representative Germany Dr. A. Hoitsma, Nijmegen 09.1995 representative the Netherlands Vacancy representative ELIAC Dr. W. van der Bij, Groningen 05.2002 representative EThAC Dr. S. Lems, Groningen 06.1996 representative TTAC Mr. T. Valkering, Eurotransplant 05.2008 secretary

TISSUE TYPING ADVISORY COMMITTEE (TTAC)

Name As of Remarks Prof.Dr. F.H.J. Claas, Leiden (ETRL) 09.1995 chairman, representative Board Prof.Dr. G. Lanzer, Graz 01.2008 representative Austria Prof.Dr. M-P. Emonds, Leuven 02.2006 representative Belgium Dr. F. Hentges, Luxembourg 09.1995 representative Luxembourg Dr. C. Schönemann, Berlin 11.2002 representative Germany Dr. J. Mytilineos, Ulm 01.2006 representative Germany Dr. S. Lems, Groningen 09.1995 representative the Netherlands Dr. B. Vidan Jeras, Ljubljana 12.1999 representative Slovenia Prof.Dr. R. Zunec, Zagreb 04.2008 representative Croatia Prof.Dr. I.I.N. Doxiadis, Leiden (ETRL) 09.1995 secretary

ETHICS COMMITTEE (ETEC)

Name As of Remarks Prof.Dr. P. Schotsmans, Leuven 01.2001 chairman, representative Board Drs. M. Bos, The Hague 05.1995 vice-chairman, representative the Netherlands Prof.Dr. W. Schaupp, Vienna 04.1998 representative Austria Prof.Dr. I. Kerremans, Gent 03.2004 representative Belgium Prof.Dr. R. Viebahn, Bochum 11.2006 representative Germany Dr. D. Rigler Pleterski, Ljubljana 01.2000 representative Slovenia Dr. J. Stoić Brezak, Zagreb 04.2008 representative Croatia Dr. A. Rahmel, Eurotransplant 12.2006 secretary a.i.

22 FINANCIAL COMMITTEE (FC)

Name As of Remarks Prof.Dr. A.P.W.P. van Montfort 05.2003 chairman, representative Board Mag. O. Postl, Vienna 05.1995 representative Austria Prof.Dr. D. Ysebaert, Antwerp 05.1995 representative Belgium Dr. H. Arbogast, Munich 11.2006 representative Germany Ms. M. Konda, Ljubljana 01.2006 representative Slovenia Mr. T. Valkering, Eurotransplant 05.2008 secretary

1.5 Recommendations approved

In 2007, the following recommendations were submitted by the Advisory Committees and approved by the Board of Eurotransplant International Foundation:

Kidney Advisory Committee (ETKAC)

RKAC01.08 1. The factor ‘ischemia time’ in total amounts to a maximum of 300 points. It is subdivided differently in the ET countries to meet the national rules: • In countries where only a national level is recognized all national recipients will receive 300 points. • In countries where a regional level is recognized all national recipients will receive 100 points and all regional recipients (i.e. recipients registered in the same region as the donor) will receive additional 200 points (a total of 300 points). • In countries where in addition to a regional level, a local level is recognized all national recipients will receive 100 points, all regional recipients receive additional 100 points (a total of 200 points) and finally all local recipients (i.e. recipients registered in the donor center or a center equivalent to the donor center) will receive again 100 additional points (a total of 300 points). 2. The waiting time points are calculated again uniformly throughout ET. All recipients will receive 33.33 points per year. There will be no upper time limit for waiting points.

RKAC02.08 Kidneys should be allocated to AB0 identical recipients. Exception should be made for: The acceptable Mismatch (AM) program: kidneys should be allocated to AB0 compatible recipients; Combined organ recipients: kidneys should be allocated according to the AB0 blood group rule of the leading organ; Rescue allocation: selection of recipients should preferably be AB0 identical. The effect of these changes should be evaluated after 5 years.

RKAC03.08 Recipients suffering from end stage renal disease after having donated one of their own kidneys, are eligible for pre-emptive listing on the kidney waiting list. The recipient will be granted an allocation bonus of 500 points upon listing.

Liver Intestine Advisory Committee (ELIAC)

RLAC01.08 All recipients younger than 16 years of age are eligible for an initial pediatric MELD equivalent to 15% probability of 3-month mortality on the waiting list. If a recipient <16 years of age with a pediatric MELD was not transplanted within 90 days, then this pediatric MELD is automatically upgraded, without the need for an active reconfirmation by the center. The upgrade equals standard an additional 10% increase in probability of 3-month mortality on the waiting list. This procedure will be performed at the end of each 90-day cycle until transplantation or removal from the waiting list. Pediatric candidates registered younger than 16 years, that turn 16 years still awaiting transplantation, will have their (upgraded) pediatric MELD frozen at the level that it was when turning 16; no further automated upgrades are performed.

RLAC02.08 In case an HU patient enters the waiting list during a running allocation procedure prior to the acceptance of the donor organ by a transplant center, the decision of the center that currently has the patient oriented first offer has to be waited for. If the

23 organ is not accepted, the donor organ shall as a next step be offered to the new HU patient (if according to a new match run, this patient would now have a higher or identical rank position to the patient for whom the offer was just turned down).

Pancreas Advisory Committee (EPAC)

RPAC01.08 In case of kidney failure after pancreas transplantation with pancreas bladder drainage but functioning pancreas, the recipient is eligible for the HU status for a kidney transplant.

RPAC02.08* The time limit for the vascularized pancreas SU status is set to three months. If a patient has not been transplanted within this time frame and the transplant center involved wants to prolong the SU status, the center will have to submit a renewed request accompanied by a well-argued letter in the English language. The request will be audited by the pancreas audit committee.

Thoracic Advisory Committee (EThAC)

RThAC01.06 rephrase Upon the first and/or re-request for an HU/U status, initially 2 auditors will be contacted. In case of a split decision, a third auditor is contacted. The urgency status of the patient remains unchanged till the third answer has been received. Only the original data at time point of request for re-evaluation need to be added to the request form. Auditors are strongly recommended to attend at least one workshop a year. The audit procedure should run via an ENIS-web based data transfer and communication system.

Organ Procurement Committee (OPC)

ROPC01.08 The Epstein Barr test results might have influence on the treatment of a post transplant recipient. Testing for Epstein Barr Virus in potential donors is mandatory; the test result is allowed to become available only after allocation. The tests result should be forwarded to the transplant centers via Eurotransplant.

ROPC02.08* Recommendation testing LUES and toxoplasmosis: The LUES and toxoplasmosis test results might have influence on the treatment of a post transplant recipient. Testing for LUES and toxoplasmosis in potential donors is mandatory; the test result is allowed to become available within 72 hours after reporting the donor (not necessary to be known for allocation). The test results should be forwarded to the recipient centers involved via Eurotransplant.

Ethics Committee (ETEC)

REC01.08 Euthanasia has to be an accepted procedure in the legal framework of the donor country. The euthanasia procedure and the determination of death after the euthanasia procedure have to be in line with national law and national practices. The euthanasia procedure itself and the explantation should follow a clear protocol. The euthanasia procedure and the organ retrieval as well as the organ allocation should be kept as separate as possible. All donors have to be reported to ET, the allocation should follow the NHBD allocation rules in the donor resp. recipient country. Organs from donors after a euthanasia procedure shall only be allocated to patients registered on the waiting list for organ transplantation in ET, and within ET, in countries that accept the transplantation of this type of donor organ. In addition the possibility to indicate the acceptance of organs from donors after a euthanasia procedure should be added to the center- and patient-specific donor profiles in ENIS.

REC02.08 Living donors should be given some kind of priority in organ allocation if they ever come into the situation to need an organ transplant themselves. The detailed rules shall be developed by the respective organ specific Advisory Committees of ET.

24 REC03.08 Appropriate measures should be taken to prevent financial hurdles that otherwise might block a living donation.

REC04.08 The ETEC recommends the Board to officially endorse the ‘Declaration of Istanbul’ (on organ trafficking and transplant tourism) and to develop steps to implement it inside the ET community.

Financial Committee (FC)

RFC01.08 Despite the strong difference between the negative result 2007 and the budget proposal 2007, the FC recommends the Board to approve the Annual Accounts 2007. Due to the negative results in 2006 and 2007, resulting in a decreased reserve position of Eurotransplant, the FC emphasizes the importance of a new financial more years plan.

RFC02.08 The Financial Committee recommends to authorize the ET budget proposal 2009, which is essential for the director’s mandate to lead the organization after January 1, 2009.

RFC03.08 The Financial Committee recommends to give a mandate to use the current and future (milestone IV) results of the ETP project in the upcoming budget negotiations with the German health care insurance companies (Krankenkassen) in order to secure the necessary budget with which ET can develop and execute its future strategy. It is suggested that the Directors work closely together in the preparation of this framework with the President and Treasurer of the Board. It is important to be aware that our negotiating partner, the German Krankenkassen are currently in a phase of rapid transition, for which reason it is considered to be very essential to conduct budget negotiations - in which the results of the ETP project are included - before the end of 2008.

Recommendation formulated by the ET directors and accepted by the Board

RET01.08 If new / updated match relevant donor information becomes available to ET after the offering procedure has started, the center that already has accepted the offer or that currently has the first offer, is made aware of the new information. The center can then decide – independent of the predefined patient- and/or center-specific donor profiles to keep / accept the organ for the patient selected based on the initial match list. If the organ is given back or the first offer is not accepted, a new match list is generated based on the new / updated match relevant donor information and the allocation is continued based on this new match list.

After the matching has been performed at the ET office, changes in patient- or center-specific donor profiles are not taken into account in this allocation procedure anymore (unless a new match has to be performed later, based on the above mentioned criteria).

*Submitted by the end of 2008, but accepted by the beginning of 2009.

25 2. Eurotransplant: donation, waiting lists and transplants

Introduction

With this year’s Annual Report we introduce a modest revision of the tables with the aim of harmonizing the layout of the tables and thereby increasing their readability. The main change concerns the splitting of all tables- where appropriate- into two sub tables: The table with the index ‘i’ gives an overview of the developments within the respective depicted area over the last five years in the whole area of Eurotransplant, whereas the table with the index ‘ii’ presents detailed information by country for the year 2008. As Croatia became full member only in 2008, the figures for this country are of course incomplete for the previous years. The Croatian centers started to report living donor procedures in 2008, therefore the figures on this procedure are not complete yet.

While the layout of the tables was changed, the sequence of the tables of this Annual Report on the other hand was kept unchanged, showing waiting list registrations, donations and transplantation activities for the different organs in the different Eurotransplant countries. Please be aware that for each of these categories (waiting list registration, donation and transplantation) an event was counted, if it was registered between 01.01.2008-0.00 and 31.12.2008-24.00. Therefore the number of donated organs and transplanted organs does not necessarily balance: if a donor is registered on New Years Eve and the corresponding transplantation takes place the following day, donation and transplantation will be assigned to two different years.

The new layout makes the dramatic and unparalleled drop in organ donation by 6.4% over the whole area of Eurotransplant in 2008 compared to 2007 even more evident. The number of donors of whom at least one organ was used for transplantation decreased in almost all countries. This decline was most pronounced in those countries that showed the biggest rise in 2007: in the Netherlands organ donation from deceased donors dropped by 21.8%, followed by Belgium (-8.9%), Germany (-7.9%) and Austria (-7.2%). Fortunately the smaller Eurotransplant member countries achieved for the most part very impressive increases in their donation rates. For example in Slovenia, host country of the celebrations of last year’s European donor day, the number of donors increased by 63.6% (s. table 2.1). There are two main reasons why the decrease in the number of utilized post-mortem donor organs did not result in a similar decrease in the number of overall transplantations: a) the fraction of multi-organ donors increased to a new high record of 77% (s. table 2.4a) and b) the number of living donor transplants increased again in 2008, in comparison to 2007 by 2.6%. In the Netherlands two-thirds of all donors were living donors (s. table 2.4b)!

It comes as no surprise that in parallel to the drop in organ donation the number of deaths on the waiting list unfortunately increased in 2008 for most organs (s. table 2.9). When comparing this table with data from previous years it has to be taken into account that in the past the number of deaths reported in the course of a year were presented, this year the table was adapted so that the figures now depict the number of deaths occurring during a year. Because sometimes a death of a patient on the waiting list is reported to Eurotransplant with substantial delay of more than a year (especially in the group of patients registered as ‘not transplantable’), the number of patients that deceased in 2008 on the waiting list might not yet be complete.

Table 2.1 Number of deceased organ donors used for a transplant, by donor country, from 2004 to 2008

Donor country population 2004 2005 2006 2007 2008 pmp 2007/2008 (millions)

a Austria 8,3 181 200 201 181 168 20,2 -7,2 % B belgium 10,7 220 237 273 291 265 24,8 -8,9 %  Croatia 4,4 0 0 0 33 79 17,8 139,4 % D Germany 82,2 1052 1185 1227 1285 1184 14,4 -7,9 % L Luxembourg 0,5 1 3 6 1 9 18,6 800,0 %  Netherlands 16,4 228 217 200 257 201 12,3 -21,8 %  Slovenia 2,0 36 21 30 22 36 17,8 63,6 %

ET 124,6 1718 1863 1937 2070 1942 15,6 -6,2 % Non-ET -- 75 82 84 69 61 -11,6 %

Total 1793 1945 2021 2139 2003 -6,4 %

26 Table 2.2(i) Number of deceased organ donors used for a transplant, by organ, from 2004 to 2008

Year of registration 2004 2005 2006 2007 2008 2007/2008

Organ donors, total 1793 1945 2021 2139 2003 -6,4 %

Kidney 1650 1753 1833 1930 1833 -5,0 % Heart 570 562 587 598 583 -2,5 % Lung 407 438 454 503 508 1,0 % Liver 1192 1302 1395 1569 1550 -1,2 % Pancreas 346 305 245 255 257 0,8 %

Table 2.2(ii) Number of deceased organ donors used for a transplant, by organ and donor country, in 2008

Donor country a B  D L   Non-ET Total

Organ donors, total 168 265 79 1184 9 201 36 61 2003

Kidney 159 235 78 1127 9 190 34 1 1833 Heart 66 78 23 370 4 26 9 7 583 Lung 59 78 14 257 1 45 9 45 508 Liver 118 207 66 976 9 135 29 10 1550 Pancreas 30 44 17 133 2 29 2 0 257

Table 2.3(i) Demographic data on deceased organ donors, used for a transplant, from 2004 to 2008

Age (years) 2004 2005 2006 2007 2008 2007/2008

0-15 75 91 67 77 73 -5,2 % 16-55 1152 1157 1202 1239 1145 -7,6 % 56-64 303 333 337 396 371 -6,3 % ≥65 263 364 415 427 414 -3,0 %

Total 1793 1945 2021 2139 2003 -6,4 %

Gender 2004 2005 2006 2007 2008 2007/2008

Female 825 891 930 969 903 -6,8 % Male 968 1054 1091 1170 1100 -6,0 %

Total 1793 1945 2021 2139 2003 -6,4 %

Blood group 2004 2005 2006 2007 2008 2007/2008

A 751 850 906 933 835 -10,5 % AB 100 127 103 125 98 -21,6 % B 194 213 216 230 248 7,8 % O 748 755 796 851 822 -3,4 %

Total 1793 1945 2021 2139 2003 -6,4 %

Cause of death 2004 2005 2006 2007 2008 2007/2008

Accident 446 475 423 471 458 -2,8 % Natural 1276 1388 1536 1612 1481 -8,1 % Suicide 51 59 42 29 47 62,1 % Other 20 23 20 27 17 -37,0 %

Total 1793 1945 2021 2139 2003 -6,4 %

27 Table 2.3(ii) Demographic data on deceased organ donors, used for a transplant, in 2008

Age (years) a B  D L   Non-et Total %

0-15 4 9 1 41 0 7 1 10 73 3,6 % 16-55 102 177 55 621 6 114 25 45 1145 57,2 % 56-64 38 41 15 209 3 56 5 4 371 18,5 % ≥65 24 38 8 313 0 24 5 2 414 20,7 %

Total 168 265 79 1184 9 201 36 61 2003 100,0 %

Gender a B  D L   Non-et Total %

Female 74 109 25 563 3 88 15 26 903 45,1 % Male 94 156 54 621 6 113 21 35 1100 54,9 %

Total 168 265 79 1184 9 201 36 61 2003 100,0 %

Blood group a B  D L   Non-et Total %

A 67 107 24 519 5 82 12 19 835 41,7 % Ab 9 11 4 59 1 6 3 5 98 4,9 % B 23 21 18 142 0 21 8 15 248 12,4 % O 69 126 33 464 3 92 13 22 822 41,0 %

Total 168 265 79 1184 9 201 36 61 2003 100,0 %

Cause of death a B  D L   Non-et Total %

Accident 48 98 20 216 3 42 9 22 458 22,9 % Natural 114 145 54 967 6 144 22 29 1481 73,9 % Suicide 5 21 4 0 0 8 5 4 47 2,3 % Other 1 1 1 1 0 7 0 6 17 0,8 %

Total 168 265 79 1184 9 201 36 61 2003 100,0 %

Table 2.4a(i) Number of donors, used for a transplant, by type of donor, from 2004 to 2008

2004 2005 2006 2007 2008 2007/2008

Deceased 1793 1945 2021 2139 2003 -6,4 % Domino 9 16 10 10 7 -30,0 % Living 919 975 1013 1118 1147 2,6 %

Total 2721 2936 3044 3267 3157 -3,4 %

Table 2.4a(ii) Number of donors, used for a transplant, by type and donor country, in 2008

Deceased % Domino % Living % Total

Austria 168 73,4 % 0 61 26,6 % 229 Belgium 265 82,0 % 0 58 18,0 % 323 Croatia 79 91,9 % 0 7 8,1 % 86 Germany 1184 65,4 % 7 0,4 % 619 34,2 % 1810 Luxembourg 9 100,0 % 0 0 9 Netherlands 201 33,4 % 0 401 66,6 % 602 Slovenia 36 100,0 % 0 0 36

Non-ET 61 98,4 % 0 1 1,6 % 62

Total 2003 63,4 % 7 0,2 % 1147 36,3 % 3157

Table 2.4b(i) Number of deceased donors, used for a transplant, by type of donor, from 2004 to 2008

2004 2005 2006 2007 2008 2007/2008

SOD 569 637 617 597 461 -22,8 % MOD 1224 1308 1404 1542 1542 0,0 %

Total 1793 1945 2021 2139 2003 -6,4 %

MOD - multiple organ donor - a donor from which more than one organ type has been used in a transplant SOD - single organ donor 28 Table 2.4b(ii) Number of deceased donors, used for a transplant, by type and donor country, in 2008

SOD % MOD % Total % of Total

Austria 43 25,6 % 125 74,4 % 168 8,4 % Belgium 70 26,4 % 195 73,6 % 265 13,2 % Croatia 14 17,7 % 65 82,3 % 79 3,9 % Germany 205 17,3 % 979 82,7 % 1184 59,1 % Luxembourg 0 0,0 % 9 100,0 % 9 0,4 % Netherlands 63 31,3 % 138 68,7 % 201 10,0 % Slovenia 7 19,4 % 29 80,6 % 36 1,8 %

Non-ET 59 96,7 % 2 3,3 % 61 3,0 %

Total 461 23,0 % 1542 77,0 % 2003 100,0 %

Table 2.4c(i) Non-heart beating (NHB) donors from 2004 to 2008

NHB Category 2004 2005 2006 2007 2008 2007/2008

I - Dead on arrival 1 0 1 1 0 -100,0 % II - Unsuccesful resuscitation 26 23 14 16 15 -6,3 % III - Awaiting heart arrest 109 129 139 165 154 -6,7 % IV - Heart arrest in brain dead donor 1 2 1 0 0 0,0 %

Not recorded 0 2 0 0 0 0,0 %

Total 137 156 155 182 169 -7,1 %

Table 2.4c(ii) Non-heart beating donors by donor country in 2008

NHB Category a B  Total %

II - Unsuccesful resuscitation 3 2 10 15 8,9 % III - Awaiting heart arrest 0 46 108 154 91,1 %

Total 3 48 118 169 100,0 %

Table 2.4d(i) Transplants from NHB donors from 2004 to 2008

2004 2005 2006 2007 2008 2007/2008

Kidney kidney 191 206 222 244 200 -18,0 % kidney en bloc 2 1 1 3 1 -66,7 %

Total 193 207 223 247 201 -18,6 %

Liver split liver 0 1 0 0 0 0,0 % whole liver 13 25 33 36 46 27,8 %

Total 13 26 33 36 46 27,8 %

Liver + Kidney liver + kidney 0 0 0 0 1 --

Total 0 0 0 0 1 --

Lung single lung 0 0 0 1 4 300,0 % double lung 0 4 4 9 12 33,3 %

Total 0 4 4 10 16 60,0 %

Pancreas pancreas 0 2 0 2 7 250,0 %

Total 0 2 0 2 7 250,0 %

Total 206 239 260 295 271 -8,14 %

29 Table 2.4d(ii) Transplants from NHB donors by donor country in 2008

Recipient country Type of transplant a B  Total %

Austria Kidney 5 3 4 12 6,0 % Belgium 0 49 4 53 26,4 % Netherlands 0 3 131 134 66,7 % Greece 0 2 0 2 1,0 %

Total Kidney 5 57 139 201 100,0 %

Austria Liver 1 0 0 1 2,2 % Belgium 0 16 1 17 37,0 % Netherlands 0 0 28 28 60,9 %

Total Liver 1 16 29 46 100,0 %

Netherlands Liver + Kidney 0 0 1 1 100,0 %

Total Liver + Kidney 0 0 1 1 100,0 %

Belgium Lung 0 4 0 4 25,0 % Netherlands 0 0 12 12 75,0 %

Total Lung 0 4 12 16 100,0 %

Belgium Pancreas 0 3 4 7 100,0 %

Total Pancreas 0 3 4 7 100,0 %

Table 2.5(i) Active Eurotransplant waiting list, by organ, as per December 31, from 2004 to 2008

Waiting list type composition 2004 2005 2006 2007 2008 2007/2008

Heart heart 713 864 904 933 989 6,0 % heart + kidney 15 18 15 24 16 -33,3 % heart + liver 0 0 1 2 2 0,0 % heart + lung 54 64 59 55 57 3,6 %

Heart Total 782 946 979 1014 1064 4,9 %

Kidney kidney 11960 11515 11069 10910 10687 -2,0 % kidney + heart 15 18 15 24 16 -33,3 % kidney + liver 70 60 62 67 72 7,5 % kidney + liver + pancreas 2 1 1 0 2 0,0 % kidney + lung 1 3 2 3 5 66,7 % kidney + pancreas 203 217 242 304 300 -1,3 %

Kidney Total 12251 11814 11391 11308 11082 -2,0 %

Liver liver 1959 2066 2249 2351 2354 0,1 % liver + heart 0 0 1 2 2 0,0 % liver + kidney 70 60 62 67 72 7,5 % liver + lung 2 3 5 4 8 100,0 % liver + pancreas 2 4 1 5 4 -20,0 % liver + pancreas + kidney 2 1 1 0 2 --

Liver Total 2035 2134 2319 2429 2442 0,5 %

Lung lung 589 668 758 849 846 -0,4 % lung + heart 54 64 59 55 57 3,6 % lung + kidney 1 3 2 3 5 66,7 % lung + liver 2 3 5 4 8 100,0 %

Lung Total 646 738 824 911 916 0,5 %

Pancreas pancreas 74 59 48 43 55 27,9 % pancreas + kidney 203 217 242 304 300 -1,3 % pancreas + kidney + liver 2 1 1 0 2 -- pancreas + liver 2 4 1 5 4 -20,0 %

Pancreas Total 281 281 292 352 361 2,6 %

30 Table 2.5(ii) Active Eurotransplant waiting list, by organ, as per December 31, 2008

Waiting list type composition a B  D L   Total %

Heart heart 53 39 18 815 0 47 17 989 93,0 % heart + kidney 5 3 0 8 0 0 0 16 1,5 % heart + liver 0 0 0 2 0 0 0 2 0,2 % heart + lung 1 1 0 48 0 7 0 57 5,4 %

Heart Total 59 43 18 873 0 54 17 1064 100,0 %

Kidney kidney 846 776 346 7703 10 935 71 10687 96,4 % kidney + heart 5 3 0 8 0 0 0 16 0,1 % kidney + liver 2 9 0 60 0 1 0 72 0,6 % kidney + liver + pancreas 0 1 0 1 0 0 0 2 0,0 % kidney + lung 0 1 0 4 0 0 0 5 0,0 % kidney + pancreas 30 23 3 227 0 16 1 300 2,7 %

Kidney Total 883 813 349 8003 10 952 72 11082 100,0 %

Liver liver 110 179 61 1875 0 116 13 2354 96,4 % liver + heart 0 0 0 2 0 0 0 2 0,1 % liver + kidney 2 9 0 60 0 1 0 72 2,9 % liver + lung 1 0 0 6 0 1 0 8 0,3 % liver + pancreas 0 0 0 4 0 0 0 4 0,2 % liver + pancreas + kidney 0 1 0 1 0 0 0 2 0,1 %

Liver Total 113 189 61 1948 0 118 13 2442 100,0 %

Lung lung 60 74 0 535 0 177 0 846 92,4 % lung + heart 1 1 0 48 0 7 0 57 6,2 % lung + kidney 0 1 0 4 0 0 0 5 0,5 % lung + liver 1 0 0 6 0 1 0 8 0,9 %

Lung Total 62 76 0 593 0 185 0 916 100,0 %

Pancreas pancreas 7 3 0 31 0 14 0 55 15,2 % pancreas + kidney 30 23 3 227 0 16 1 300 83,1 % pancreas + kidney + liver 0 1 0 1 0 0 0 2 0,6 % pancreas + liver 0 0 0 4 0 0 0 4 1,1 %

Pancreas Total 37 27 3 263 0 30 1 361 100,0 %

Table 2.6(i) Registration events on the Eurotransplant waiting list, by organ, from 2004 to 2008

All registration events 2004 2005 2006 2007 2008 2007/2008

Kidney 5404 5209 5335 6212 5808 -6,5 % Heart 1048 1053 1009 1015 1052 3,6 % Lung 695 723 739 805 846 5,1 % Liver 2367 2302 2515 2631 2675 1,7 % Pancreas 394 374 317 365 341 -6,6 %

Total 9908 9661 9915 11028 10722 -2,8 %

New registration events 2004 2005 2006 2007 2008 2007/2008

Kidney 4564 4354 4553 5398 4967 -8,0 % Heart 1016 1025 975 992 1030 3,8 % Lung 660 681 696 748 799 6,8 % Liver 2085 1994 2203 2338 2372 1,5 % Pancreas 327 304 273 304 281 -7,6 %

Total 8652 8358 8700 9780 9449 -3,4 %

Re-registration events 2004 2005 2006 2007 2008 2007/2008

Kidney 840 855 782 814 841 3,3 % Heart 32 28 34 23 22 -4,3 % Lung 35 42 43 57 47 -17,5 % Liver 282 308 312 293 303 3,4 % Pancreas 67 70 44 61 60 -1,6 %

Total 1256 1303 1215 1248 1273 2,0 %

31 Table 2.6(ii) Registration events on the Eurotransplant waiting list, by organ and country, in 2008

All registration events a B  D L   Total %

Kidney 459 527 169 3599 5 1004 45 5808 54,2 % Heart 84 113 44 733 0 66 12 1052 9,8 % Lung 135 120 0 476 0 115 0 846 7,9 % Liver 173 334 103 1866 0 168 31 2675 24,9 % Pancreas 39 41 11 222 0 28 0 341 3,2 %

Total 890 1135 327 6896 5 1381 88 10722 100,0 %

New registration events a B  D L   Total %

Kidney 365 455 164 3064 5 870 44 4967 52,6 % Heart 81 110 44 719 0 64 12 1030 10,9 % Lung 128 116 0 442 0 113 0 799 8,5 % Liver 149 302 101 1649 0 143 28 2372 25,1 % Pancreas 29 24 10 197 0 21 0 281 3,0 %

Total 752 1007 319 6071 5 1211 84 9449 100,0 %

Re- registration events a B  D L   Total %

Kidney 94 72 5 535 0 134 1 841 66,1 % Heart 3 3 0 14 0 2 0 22 1,7 % Lung 7 4 0 34 0 2 0 47 3,7 % Liver 24 32 2 217 0 25 3 303 23,8 % Pancreas 10 17 1 25 0 7 0 60 4,7 %

Total 138 128 8 825 0 170 4 1273 100,0 %

Re-registrations for multiple organs are counted under each waiting list respectively

Table 2.7(i) Number of transplanted organs**, by organ, by donor type, from* 2004 to 2008

Deceased 2004 2005 2006 2007 2008 2007/2008

Kidney 3206 3406 3539 3728 3522 -5,5 % Heart 571 563 587 598 581 -2,8 % Lung 773 839 871 960 972 1,3 % Liver 1262 1364 1436 1625 1606 -1,2 % Pancreas 346 304 247 255 256 0,4 %

Total 6158 6476 6680 7166 6937 -3,2 %

Living 2004 2005 2006 2007 2008 2007/2008

Kidney 803 865 901 1032 1088 5,4 % Heart (domino) 1 1 0 0 0 0,0 % Liver (partial and domino) 106 121 116 101 82 -18,8 %

Total 910 987 1017 1133 1170 3,3 %

Table 2.7(ii) number of transplanted organs**, by organ, by donor type, by country of transplant, in* 2008

Deceased a B  D L   Non-ET Total %

Kidney 303 448 150 2207 3 356 52 3 3522 50,8 % Heart 62 75 20 382 0 32 6 4 581 8,4 % Lung 225 149 0 500 0 98 0 0 972 14,0 % Liver 112 217 64 1060 0 129 22 2 1606 23,2 % Pancreas 34 51 14 139 0 18 0 0 256 3,7 %

Total 736 940 248 4288 3 633 80 9 6937 100,0 %

Living a B  D L   Non-ET Total %

Kidney 57 45 9 565 0 411 0 1 1088 93,0 % Liver (partial and domino) 4 13 1 62 0 2 0 0 82 7,0 %

Total 61 58 10 627 0 413 0 1 1170 100,0 %

* based on transplant registration date ** each liver split counted as one ** each kidney en bloc counted as two ** each double lung counted as two 32 Table 2.8(i) Transplants from 2004 to 2008

Deceased Donors 2004 2005 2006 2007 2008 2007/2008

Heart 537 531 539 562 544 -3,2 % Kidney 2866 3094 3220 3415 3179 -6,9 % Kidney en bloc 22 22 20 24 28 16,7 % Single lung 99 103 120 89 82 -7,9 % Double lung 316 345 338 410 419 2,2 % Liver 1058 1196 1273 1439 1405 -2,4 % Split liver 146 119 90 105 113 7,6 % Heart + single kidney 13 10 15 13 10 -23,1 % Heart + double lung 18 21 30 21 23 9,5 % Heart + liver 3 1 1 2 3 50,0 % Kidney + single lung 0 0 0 1 0 -100,0 % Kidney + double lung 1 1 3 0 1 -- Kidney + liver 42 41 61 65 73 12,3 % Kidney + split liver 5 2 2 4 4 0,0 % Liver + kidney en bloc 0 1 1 1 2 100,0 % Liver + single lung 0 0 1 0 0 -- Liver + double lung 2 1 2 4 1 -75,0 % Heart + double lung + kidney 0 0 0 0 1 -- Heart + double lung + liver 0 0 2 0 0 0,0 % Pancreas 34 31 31 29 20 -31,0 % Pancreas + kidney 229 209 195 180 194 7,8 % Pancreas + kidney en bloc 1 0 0 0 0 0,0 % Pancreas + liver 6 2 2 5 5 0,0 % Pancreas + liver + kidney 0 1 1 1 0 -100,0 % Pancreas islets 23 17 5 15 17 13,3 % Pancreas islets + kidney 4 2 0 0 0 0,0 %

Total (deceased donors) transplants 5425 5750 5952 6385 6124 -4,1 %

Living Donors 2004 2005 2006 2007 2008 2007/2008

Heart (domino) 1 1 0 0 0 0,0 % Kidney 803 865 901 1032 1087 5,3 % Kidney + Liver 0 0 0 0 1 -- Liver (partial and domino) 106 121 116 101 81 -19,8 %

Total (living donors) transplants 910 987 1017 1133 1169 3,2 %

All donors 2004 2005 2006 2007 2008 2007/2008

Total transplants 6335 6737 6969 7518 7293 -3,0 %

33 Table 2.8(ii) Transplants in 2008, by transplant country

Deceased donor transplants a B  D L   Non-ET Total % of deceased donor transplants

Heart 57 71 20 355 0 31 6 4 544 8,5 % Kidney 263 407 131 1988 3 332 52 3 3179 49,9 % Kidney en bloc 0 6 1 17 0 4 0 0 28 0,4 % Single lung 13 15 0 40 0 14 0 0 82 1,3 % Double lung 103 65 0 210 0 41 0 0 419 6,6 % Liver 104 186 61 915 0 116 22 1 1405 22,0 % Split liver 1 17 0 86 0 8 0 1 113 1,8 % Heart + single kidney 2 2 0 6 0 0 0 0 10 0,2 % Heart + double lung 3 1 0 18 0 1 0 0 23 0,4 % Heart + liver 0 1 0 2 0 0 0 0 3 0,0 % Kidney + single lung 0 0 0 0 0 0 0 0 0 -- Kidney + double lung 0 0 0 1 0 0 0 0 1 0,0 % Kidney + liver 7 10 3 49 0 4 0 0 73 1,1 % Kidney + split liver 0 1 0 3 0 0 0 0 4 0,1 % Liver + kidney en bloc 0 0 0 2 0 0 0 0 2 0,0 % Liver + single lung 0 0 0 0 0 0 0 0 0 -- Liver + double lung 0 1 0 0 0 0 0 0 1 0,0 % Heart + double lung + kidney 0 0 0 1 0 0 0 0 1 0,0 % Heart + double lung + liver 0 0 0 0 0 0 0 0 0 -- Pancreas 3 2 0 13 0 2 0 0 20 0,3 % Pancreas + kidney 31 16 14 121 0 12 0 0 194 3,0 % Pancreas + liver 0 1 0 3 0 1 0 0 5 0,1 % Pancreas + liver + kidney 0 0 0 0 0 0 0 0 0 -- Pancreas islets 0 12 0 2 0 3 0 0 17 0,3 % Pancreas islets + kidney 0 0 0 0 0 0 0 0 0 --

Total (deceased donors) transplants 587 814 230 3832 3 569 80 9 6124 100,0 %

Living donor transplants a B  D L   Non-ET Total % of living donor transplants

Kidney 57 45 9 564 0 411 0 1 1087 93,0 % Kidney + Liver 0 0 0 1 0 0 0 0 1 0,1 % Liver (partial and domino) 4 13 1 61 0 2 0 0 81 6,9 %

Total (living donors) transplants 61 58 10 626 0 413 0 1 1169 100,0 %

All donors a B  D L   Non-ET Total

Total transplants 648 872 240 4458 3 982 80 10 7293

Table 2.9(i) Mortality on the Eurotransplant waiting list, by date of death, from 2004 to 2008

Waiting list 2004 2005 2006 2007 2008 2007/2008

Kidney 643 564 512 476 410 -13,9 % Liver 390 455 469 433 463 6,9 % Pancreas 22 20 22 19 25 31,6 % Heart 230 219 249 211 196 -7,1 % Lung 144 150 121 115 159 38,3 %

Total 1429 1408 1373 1254 1253 -0,1 %

Table 2.9(ii) Mortality on the Eurotransplant waiting list in 2008

Waiting list a B  D L   Total

Kidney 39 18 5 267 0 77 4 410 Liver 31 44 23 339 0 22 4 463 Pancreas 0 1 1 22 0 1 0 25 Heart 7 19 7 149 0 12 2 196 Lung 13 6 0 112 0 28 0 159

Total 90 88 36 889 0 140 10 1253

34 3. Kidney: donation, waiting lists and transplants

Table 3.1(i) Deceased donors / kidneys in Eurotransplant, from 2004 to 2008

Donors

Deceased donors 2004 2005 2006 2007 2008 2007/2008

All donors 2071 2249 2299 2411 2233 -7,4 % Non-kidney donors 253 252 242 216 217 0,5 % Kidney donors 1818 1997 2057 2195 2016 -8,2 % Kidney donors not used 168 244 224 265 183 -30,9 % One kidney used 87 104 121 145 138 -4,8 % Two kidneys used 1563 1649 1712 1785 1695 -5,0 % Total kidney donors used 1650 1753 1833 1930 1833 -5,0 %

Kidneys

Year 2004 2005 2006 2007 2008 2007/2008

Reported 3618 3960 4081 4365 3999 -8,4 % Offered 3525 3835 3946 4208 3912 -7,0 % Accepted 3356 3599 3713 3952 3711 -6,1 % Transplanted 3213 3402 3545 3715 3528 -6,1 %

Table 3.1(ii) Deceased donors / kidneys in Eurotransplant in 2008

Donors

Deceased Donors a B  D L   Total ET Non-ET Total % all donors

All donors 179 299 84 1226 9 240 39 2076 157 2233 100,0 % Non-kidney donors 6 26 1 38 0 5 0 76 141 217 10,0 % Kidney donors 173 273 83 1188 9 235 39 2000 16 2016 90,0 % Kidney donors not used 14 38 5 61 0 45 5 168 15 183 8,0 % One kidney used 13 24 5 64 0 27 4 137 1 138 6,0 % Two kidneys used 146 211 73 1063 9 163 30 1695 0 1695 76,0 % Total kidney donors used 159 235 78 1127 9 190 34 1832 1 1833 82,0 %

Kidneys

Donor country a B  D L   Total ET Non-ET Total % reported

Reported 339 544 165 2367 18 468 77 3978 21 3999 100,0 % Offered 337 530 165 2362 18 406 76 3894 18 3912 98,0 % Accepted 326 487 160 2272 18 376 67 3706 5 3711 93,0 % Transplanted 305 446 151 2190 18 353 64 3527 1 3528 88,0 %

Table 3.2(i) Active kidney transplant waiting list, as per December 31, from 2004 to 2008 - characteristics

Type of transplant 2004 2005 2006 2007 2008 2007/2008

Kidney 11960 11515 11071 10910 10687 -2,0 % Kidney + heart 15 18 15 24 16 -33,3 % Kidney + liver 70 60 62 67 72 7,5 % Kidney + liver + pancreas 2 1 1 0 2 -- Kidney + lung 1 3 2 3 5 66,7 % Kidney + pancreas 203 217 242 304 300 -1,3 %

Total 12251 11814 11393 11308 11082 -2,0 %

35 Table 3.2(ii) Active kidney transplant waiting list, as per December 31 , 2008 - characteristics

Type of transplant a B  D L   Total %

Kidney 846 776 346 7703 10 935 71 10687 96,4 % Kidney + heart 5 3 0 8 0 0 0 16 0,1 % Kidney + liver 2 9 0 60 0 1 0 72 0,6 % Kidney + liver + pancreas 0 1 0 1 0 0 0 2 0,0 % Kidney + lung 0 1 0 4 0 0 0 5 0,0 % Kidney + pancreas 30 23 3 227 0 16 1 300 2,7 %

Total 883 813 349 8003 10 952 72 11082 100,0 %

Table 3.3(i) Active kidney-only transplant waiting list, as per december 31, from 2004 to 2008 - characteristics

Blood group 2004 2005 2006 2007 2008 2007/2008

A 4624 4423 4083 3924 3770 -3,9 % Ab 250 212 213 144 175 21,5 % B 1346 1312 1286 1306 1264 -3,2 % O 5740 5568 5489 5536 5478 -1,0 %

Total 11960 11515 11071 10910 10687 -2,0 %

% Pra current 2004 2005 2006 2007 2008 2007/2008

0-5 % 10698 10341 9964 9741 9347 -4,0 % 6-84 % 1108 1006 960 997 1182 18,6 % 85-100,0 % 113 134 96 113 100 -11,5 % Not reported 41 34 51 59 58 -1,7 %

Total 11960 11515 11071 10910 10687 -2,0 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 10057 9596 9264 9159 8943 -2,4 % Repeat 1903 1919 1807 1751 1744 -0,4 %

Total 11960 11515 11071 10910 10687 -2,0 %

Waiting time (years) basis dialysis date 2004 2005 2006 2007 2008 2007/2008

Pre-emptive 257 286 239 275 326 18,5 % 0-1 2911 2699 2516 2401 2363 -1,6 % 2-4 5783 5523 5320 5269 5054 -4,1 % 5+ 3009 3007 2996 2965 2944 -0,7 %

Total 11960 11515 11071 10910 10687 -2,0 %

Waiting time (years) basis date put on wl 2004 2005 2006 2007 2008 2007/2008

0-1 5315 5101 4827 5047 5069 0,4 % 2-4 4800 4624 4494 4197 3950 -5,9 % 5+ 1845 1790 1750 1666 1668 0,1 %

Total 11960 11515 11071 10910 10687 -2,0 %

Table 3.3(ii) Active kidney-only transplant waiting list, as per december 31, 2008 - characteristics

Blood group a B  D L   Total %

A 327 239 126 2785 4 264 25 3770 35,3 % Ab 8 12 11 129 0 14 1 175 1,6 % B 99 72 52 888 1 144 8 1264 11,8 % O 412 453 157 3901 5 513 37 5478 51,3 %

Total 846 776 346 7703 10 935 71 10687 100,0 %

36 Table 3.3(ii) (Continued)

% Pra current a B  D L   Total %

0-5 % 718 681 287 6785 10 803 63 9347 87,5 % 6-84 % 112 84 31 829 0 118 8 1182 11,1 % 85-100 % 8 10 1 71 0 10 0 100 0,9 % Not reported 8 1 27 18 0 4 0 58 0,5 %

Total 846 776 346 7703 10 935 71 10687 100,0 %

Sequence a B  D L   Total %

First 637 601 341 6541 9 744 70 8943 83,7 % Repeat 209 175 5 1162 1 191 1 1744 16,3 %

Total 846 776 346 7703 10 935 71 10687 100,0 %

Waiting time (years) basis dialysis date a B  D L   Total %

Pre emptive 35 79 2 120 0 86 4 326 3,1 % 0-1 287 319 86 1382 5 274 10 2363 22,1 % 2-4 442 305 154 3654 5 454 40 5054 47,3 % 5+ 82 73 104 2547 0 121 17 2944 27,5 %

Total 846 776 346 7703 10 935 71 10687 100,0 %

Waiting time (years) basis date put on wl a B  D L   Total %

0-1 496 482 342 3250 7 447 45 5069 47,4 % 2-4 316 230 3 3000 3 377 21 3950 37,0 % 5+ 34 64 1 1453 0 111 5 1668 15,6 %

Total 846 776 346 7703 10 935 71 10687 100,0 %

Table 3.4(i) Kidney transplant characteristics from 2004 to 2008 Deceased donor kidney transplants

Type of transplant 2004 2005 2006 2007 2008 2007/2008

Kidney-only 2866 3094 3220 3415 3179 -6,9 % Kidney en bloc 24 22 20 24 28 16,7 % Kidney + pancreas 233 211 195 180 194 7,8 % Kidney + heart 13 10 15 13 10 -23,1 % Kidney + split liver 5 2 2 4 4 0,0 % Kidney + whole liver 42 41 61 64 73 14,1 % Kidney en bloc + pancreas 1 0 0 0 0 0,0 % Kidney en bloc + whole liver 0 1 1 1 2 100,0 % Kidney + pancreas + whole liver 0 1 1 1 0 -100,0 % Kidney + single lung 0 0 0 1 0 -100,0 % Kidney + double lungs 1 1 3 0 1 -- Kidney + heart + double lungs 0 0 0 0 1 --

Total 3185 3383 3518 3703 3492 -5,7 %

Kidney- only transplant (including kidney en bloc)

Hla - a, b, dr mismatches 2004 2005 2006 2007 2008 2007/2008

0 482 475 515 459 448 -2,4 % 1 223 230 239 258 253 -1,9 % 2 745 760 756 743 744 0,1 % 3 814 895 911 1009 890 -11,8 % 4 367 430 463 530 485 -8,5 % 5 179 217 215 300 265 -11,7 % 6 42 62 96 105 99 -5,7 % Not determined 38 47 45 35 23 -34,3 %

Total 2890 3116 3240 3439 3207 -6,7 %

37 Table 3.4(i) (Continued)

Blood group 2004 2005 2006 2007 2008 2007/2008

A 1190 1361 1435 1530 1404 -8,2 % AB 197 247 202 243 185 -23,9 % B 322 374 395 413 431 4,4 % O 1181 1134 1208 1253 1187 -5,3 %

Total 2890 3116 3240 3439 3207 -6,7 %

PRA 2004 2005 2006 2007 2008 2007/2008

0-5% 2566 2841 2887 3097 2883 -6,9 % 6-84% 291 242 312 293 286 -2,4 % 85-100% 27 28 34 39 35 -10,3 % Not reported 6 5 7 10 3 -70,0 %

Total 2890 3116 3240 3439 3207 -6,7 %

Waiting time (months) 2004 2005 2006 2007 2008 2007/2008

Pre-emptive 37 35 42 38 43 13,2 % 0-5 35 48 45 47 45 -4,3 % 6-11 114 93 107 131 108 -17,6 % 12-23 333 315 369 407 350 -14,0 % 24-59 1034 1231 1244 1262 1149 -9,0 % 60 + 1337 1394 1433 1554 1512 -2,7 %

Total 2890 3116 3240 3439 3207 -6,7 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 2449 2670 2717 2903 2731 -5,9 % Repeat 441 446 523 536 476 -11,2 %

Total 2890 3116 3240 3439 3207 -6,7 %

Table 3.4(ii) Kidney transplant characteristics - 2008

Deceased donor kidney transplants

Type of transplant a B  D L   Total ET Non-ET Total %

Kidney-only 263 407 131 1988 3 332 52 3176 3 3179 91,0 % Kidney en bloc 0 6 1 17 0 4 0 28 0 28 0,8 % Kidney + pancreas 31 16 14 121 0 12 0 194 0 194 5,6 % Kidney + heart 2 2 0 6 0 0 0 10 0 10 0,3 % Kidney + both lungs 0 0 0 1 0 0 0 1 0 1 0,0 % Kidney en bloc + whole liver 0 0 0 2 0 0 0 2 0 2 0,1 % Kidney + split liver 0 1 0 3 0 0 0 4 0 4 0,1 % Kidney + whole liver 7 10 3 49 0 4 0 73 0 73 2,1 % Kidney + heart + both lungs 0 0 0 1 0 0 0 1 0 1 0,0 %

Total 303 442 149 2188 3 352 52 3489 3 3492 100,0 %

Kidney-only transplant (including kidney en bloc)

HLA - A, B, DR mismatches a B  D L   Total ET Non-ET Total %

0 32 24 8 345 0 32 7 448 0 448 14,0 % 1 12 37 4 161 0 38 1 253 0 253 7,9 % 2 49 137 27 422 2 92 15 744 0 744 23,2 % 3 90 153 47 473 1 104 22 890 0 890 27,8 % 4 51 51 31 301 0 45 6 485 0 485 15,1 % 5 23 4 14 209 0 14 1 265 0 265 8,3 % 6 4 2 0 83 0 10 0 99 0 99 3,1 % Not determined 2 5 1 11 0 1 0 20 3 23 0,7 %

Total 263 413 132 2005 3 336 52 3204 3 3207 100,0 %

38 Table 3.4(ii) (Continued)

Blood group a B  D L   Total ET Non-ET Total %

A 124 179 44 909 0 129 19 1404 0 1404 43,8 % Ab 18 14 4 140 0 5 2 183 2 185 5,8 % B 36 39 31 268 0 44 13 431 0 431 13,4 % O 85 181 53 688 3 158 18 1186 1 1187 37,0 %

Total 263 413 132 2005 3 336 52 3204 3 3207 100,0 %

Pra a B  D L   Total ET Non-ET Total %

0-5% 235 376 119 1809 2 293 49 2883 0 2883 89,9 % 6-84% 26 36 12 170 1 38 3 286 0 286 8,9 % 85-100% 2 1 1 26 0 5 0 35 0 35 1,1 % Not reported 0 0 0 0 0 0 0 0 3 3 0,1 %

Total 263 413 132 2005 3 336 52 3204 3 3207 100,0 %

Waiting time (months) a B  D L   Total ET Non-ET Total %

0-5 11 13 0 18 0 3 0 45 0 45 1,4 % 6-11 11 36 1 49 1 10 0 108 0 108 3,4 % 12-23 45 76 5 186 0 32 6 350 0 350 10,9 % 24-59 135 206 31 564 1 183 29 1149 0 1149 35,8 % 60 + 57 62 95 1180 1 100 17 1512 0 1512 47,1 % Pre-emptive 4 20 0 8 0 8 0 40 3 43 1,3 %

Total 263 413 132 2005 3 336 52 3204 3 3207 100,0 %

Sequence a B  D L   Total ET Non-ET Total %

First 205 368 129 1693 2 281 50 2728 3 2731 85,2 % Repeat 58 45 3 312 1 55 2 476 0 476 14,8 %

Total 263 413 132 2005 3 336 52 3204 3 3207 100,0 %

Table 3.5(i) Living donor kidney transplants - kidney-only from 2004 to 2008

Kidney-only 2004 2005 2006 2007 2008 2007/2008

Related 478 500 517 587 609 3,7 % Non-related 325 365 384 445 479 7,6 %

Total 803 865 901 1032 1088 5,4 %

Related 2004 2005 2006 2007 2008 2007/2008

Brother / sister 158 155 156 181 195 7,7 % Father 106 102 115 128 136 6,3 % Mother 163 178 187 211 209 -0,9 % Son / daughter 25 32 26 26 39 50,0 % Grandfather / -mother 3 6 10 5 6 20,0 % Grandchild 0 1 0 0 0 0,0 % Uncle / aunt 9 13 12 11 14 27,3 % Nephew / niece 12 12 9 15 4 -73,3 % Cousin 0 0 0 0 2 -- Blood related: nos* 2 1 2 10 4 -60,0 %

Total 478 500 517 587 609 3,7 %

Non-related 2004 2005 2006 2007 2008 2007/2008

Anonymous donor 0 0 0 6 20 233,3 % Friend 0 0 0 29 41 41,4 % Not blood related family 20 17 26 29 33 13,8 % Not blood related: nos* 14 8 3 4 3 -25,0 % Not related 36 71 74 63 49 -22,2 % Spouse / partner 255 269 281 314 333 6,1 %

Total 325 365 384 445 479 7,6 %

* NOS - Not otherwise specified 39 Table 3.5(ii) Living donor kidney transplants - kidney-only - 2008

Kidney-only a B  D  Non-ET Total %

Related 33 33 5 336 201 1 609 56,0 % Non-related 24 12 4 229 210 0 479 44,0 %

Total 57 45 9 565 411 1 1088 100,0 %

Related a B  D  Non-ET Total %

Brother / sister 10 8 2 99 76 0 195 32,0 % Father 6 7 0 79 43 1 136 22,3 % Mother 16 13 1 134 45 0 209 34,3 % Son / daughter 0 3 0 9 27 0 39 6,4 % Grandfather / - mother 0 0 0 4 2 0 6 1,0 % Uncle / aunt 1 1 2 8 2 0 14 2,3 % Nephew / niece 0 0 0 1 3 0 4 0,7 % Cousin 0 0 0 1 1 0 2 0,3 % Blood related: nos * 0 1 0 1 2 0 4 0,7 %

Total 33 33 5 336 201 1 609 100,0 %

Non-related a B  D  Non-ET Total %

Anonymous donor 0 0 0 0 20 0 20 4,2 % Friend 4 0 0 10 27 0 41 8,6 % Not blood related family 1 0 0 14 18 0 33 6,9 % Not blood related: nos* 0 0 0 0 3 0 3 0,6 % Not related 0 1 0 1 47 0 49 10,2 % Spouse / partner 19 11 4 204 95 0 333 69,5 %

Total 24 12 4 229 210 0 479 100,0 %

* NOS - Not otherwise specified

Figure 3.1 Dynamics of the Eurotransplant kidney transplant waiting list and transplants between 1969 and 2008

14000

12000

10000

8000

6000

4000

2000

0 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1991 1993 1995 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Kidney waiting list 450 892 1147 1200 934 1929 2135 2928 5150 6740 8376 9418 10510 11324 11975 12313 12524 12450 12653 12382 12251 11814 11393 11308 11082 Living donor transplants 9 5 11 33 33 33 53 108 150 161 129 127 212 411 526 579 569 617 697 646 803 865 901 1032 1088 Deceased donor transplants 102 228 454 583 800 1050 1263 1645 1965 2665 3395 3293 3064 3110 3068 3050 3145 3121 3047 3352 3185 3383 3518 3703 3492

40 4. Thoracic organs: donation, waiting lists and transplants

Table 4.1(i) Deceased donors / hearts in Eurotransplant from 2004 to 2008

Donors

Year of registration 2004 2005 2006 2007 2008 2007/2008

All donors 2071 2249 2299 2411 2233 -8,0 % Non-heart donors 1051 1148 1267 1296 1195 -8,5 % Heart donors 1020 1101 1032 1115 1038 -7,4 % Heart donors not used 450 539 445 517 455 -13,6 % Total heart donors used 570 562 587 598 583 -2,6 %

Hearts

Year of registration 2004 2005 2006 2007 2008 2007/2008

Reported 1020 1101 1032 1115 1038 -7,4 % Offered 919 970 943 977 895 -9,2 % Accepted 705 749 750 750 704 -6,5 % Transplanted 570 562 587 598 583 -2,6 %

Table 4.1(ii) Deceased donors / hearts in Eurotransplant in 2008

Donors

Deceased Donors a B  D L   Total ET Non-ET Total % all donors

All donors 179 299 84 1226 9 240 39 2076 157 2233 100,0 % Non-heart donors 85 104 52 704 2 131 17 1095 100 1195 54,0 % Heart donors 94 195 32 522 7 109 22 981 57 1038 46,0 % Heart donors not used 28 117 9 152 3 83 13 405 50 455 20,0 % Total heart donors used 66 78 23 370 4 26 9 576 7 583 26,0 %

Hearts

Donor country a B  D L   Total ET Non-ET Total % reported

Reported 94 195 32 522 7 109 22 981 57 1038 100,0 % Offered 92 120 32 520 6 49 22 841 54 895 86,0 % Accepted 75 91 29 446 4 30 11 686 18 704 68,0 % Transplanted 66 78 23 370 4 26 9 576 7 583 56,0 %

Table 4.2(i) Deceased donors / lungs in Eurotransplant from 2004 to 2008

Donors

Year of registration 2004 2005 2006 2007 2008 2007/2008

All donors 2071 2249 2299 2411 2233 -7,4 % Non-lung donors 1380 1429 1507 1509 1383 -8,3 % Lung donors 691 820 792 902 850 -5,8 % Lung donors not used 284 382 338 399 342 -14,3 % One lung used 41 41 37 44 44 0,0 % Two lungs used 366 397 417 459 464 1,1 % Total lung donors used 407 438 454 503 508 1,0 %

41 Table 4.2(i) (Continued)

Lungs

Year of registration 2004 2005 2006 2007 2008 2007/2008

Reported 1351 1609 1556 1787 1676 -6,2 % Offered 1311 1553 1516 1758 1645 -6,4 % Accepted 982 1141 1154 1333 1283 -3,8 % Transplanted 773 835 871 962 972 1,0 %

Table 4.2(ii) Deceased donors / lungs in Eurotransplant in 2008

Donors

Donor country a B  D L   Total ET Non-ET Total % all donors

All donors 179 299 84 1226 9 240 39 2076 157 2233 100,0 % Non-lung donors 98 176 62 805 8 155 21 1325 58 1383 62,0 % Lung donors 81 123 22 421 1 85 18 751 99 850 38,0 % Lung donors not used 22 45 8 164 0 40 9 288 54 342 15,0 % One lung used 3 8 1 19 0 9 0 40 4 44 2,0 % Two lungs used 56 70 13 238 1 36 9 423 41 464 21,0 % Total lung donors used 59 78 14 257 1 45 9 463 45 508 23,0 %

Lungs

Donor country a B  D L   Total ET Non-ET Total % reported

Reported 162 240 44 838 2 166 35 1487 189 1676 100,0 % Offered 157 238 44 831 2 162 34 1468 177 1645 98,0 % Accepted 143 183 37 661 2 112 18 1156 127 1283 77,0 % Transplanted 115 148 27 495 2 81 18 886 86 972 58,0 %

Table 4.3(i) Active heart transplant waiting list, as per December 31, from 2004 to 2008 - characteristics

2004 2005 2006 2007 2008 2007/2008

Heart 713 864 904 933 989 6,0 % Heart + kidney 15 18 15 24 16 -33,3 % Heart + liver 0 0 1 2 2 0,0 % Heart + lung 54 64 59 55 57 3,6 %

Total 782 946 979 1014 1064 4785

Table 4.3(ii) Active heart transplant waiting list as per December 31, 2008 - characteristics

a B  D   Total %

Heart 53 39 18 815 47 17 989 93,0 % Heart + kidney 5 3 0 8 0 0 16 1,5 % Heart + liver 0 0 0 2 0 0 2 0,2 % Heart + lung 1 1 0 48 7 0 57 5,4 %

Total 59 43 18 873 54 17 1064 100,0 %

Table 4.4(i) Active heart-only transplant waiting list as per December 31, from 2004 to 2008 - characteristics

Blood group 2004 2005 2006 2007 2008 2007/2008

A 360 419 434 442 469 6,1 % AB 7 17 17 22 22 0,0 % B 77 105 89 93 97 4,3 % O 269 323 364 376 401 6,6 %

Total 713 864 904 933 989 6,0 %

42 Table 4.4(i) (Continued)

% PRA current 2004 2005 2006 2007 2008 2007/2008

0-5 % 432 527 554 561 613 9,3 % 6-84 % 9 18 15 16 22 37,5 % 85-100 % 1 1 2 0 0 0,0 % Not reported 271 318 333 356 354 -0,6 %

Total 713 864 904 933 989 6,0 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 700 849 885 923 979 6,1 % Repeat 13 15 19 10 10 0,0 %

Total 713 864 904 933 989 6,0 %

Waiting time (months) basis date put on wl 2004 2005 2006 2007 2008 2007/2008

0-5 321 344 298 330 303 -8,2 % 6-11 179 192 180 168 209 24,4 % 12-23 168 218 228 203 216 6,4 % 24+ 45 110 198 232 261 12,5 %

Total 713 864 904 933 989 6,0 %

Table 4.4(ii) Active heart-only transplant waiting list as per December 31, 2008 - characteristics

Blood group a B  D   Total %

A 29 17 8 387 20 8 469 47,4 % Ab 1 3 0 18 0 0 22 2,2 % B 4 4 2 78 6 3 97 9,8 % O 19 15 8 332 21 6 401 40,5 %

Total 53 39 18 815 47 17 989 100,0 %

% PRA current a B  D   Total %

0-5 % 11 16 8 532 46 0 613 62,0 % 6-84 % 1 2 0 18 1 0 22 2,2 % Not reported 41 21 10 265 0 17 354 35,8 %

Total 53 39 18 815 47 17 989 100,0 %

Sequence a B  D   Total %

First 53 39 18 805 47 17 979 99,0 % Repeat 0 0 0 10 0 0 10 1,0 %

Total 53 39 18 815 47 17 989 100,0 %

Waiting time (months) basis date put on wl a B  D   Total %

0-5 21 27 10 226 14 5 303 30,6 % 6-11 14 8 7 165 14 1 209 21,1 % 12-23 9 3 1 182 15 6 216 21,8 % 24+ 9 1 0 242 4 5 261 26,4 %

Total 53 39 18 815 47 17 989 100,0 %

43 Table 4.5(i) Active heart + lung transplant waiting list as per December 31, from 2004 to 2008 - characteristics

Type of transplant 2004 2005 2006 2007 2008 2007/2008

Heart + lung 54 64 59 55 57 3,6 %

Total 54 64 59 55 57 3,6 %

Table 4.5(ii) Active heart + lung transplant waiting list, as per December 31, 2008 - characteristics

Type of transplant a B D  Total %

Heart + lung 1 1 48 7 57 100,0 %

Total 1 1 48 7 57 100,0 %

Table 4.6(i) Active heart + lung transplant waiting list as per December 31, from 2004 to 2008 - characteristics

Blood group 2004 2005 2006 2007 2008 2007/2008

A 24 25 24 25 27 8,0 % AB 2 1 3 1 1 0,0 % B 4 6 4 4 5 25,0 % O 24 32 28 25 24 -4,0 %

Total 54 64 59 55 57 3,6 %

% PRA current 2004 2005 2006 2007 2008 2007/2008

0-5 % 23 35 38 32 32 0,0 % 6-84 % 2 1 0 0 0 0,0 % Not reported 29 28 21 23 25 8,7 %

Total 54 64 59 55 57 3,6 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 54 64 58 55 57 3,6 % Repeat 0 0 1 0 0 0,0 %

Total 54 64 59 55 57 3,6 %

Waiting time (months) basis date put on wl 2004 2005 2006 2007 2008 2007/2008

0-5 17 16 9 14 11 -21,4 % 6-11 11 12 8 8 11 37,5 % 12-23 15 17 19 7 14 100,0 % 24+ 11 19 23 26 21 -19,2 %

Total 54 64 59 55 57 3,6 %

Table 4.6(ii) Active heart + lung transplant waiting list as per December 31, 2008 - characteristics

Blood group a B D  Total %

A 0 0 24 3 27 47,4 % AB 0 0 1 0 1 1,8 % B 0 1 3 1 5 8,8 % O 1 0 20 3 24 42,1 %

Total 1 1 48 7 57 100,0 %

44 Table 4.6(ii) (Continued)

% PRA current a B D  Total %

0-5 % 0 0 27 5 32 56,1 % Not reported 1 1 21 2 25 43,9 %

Total 1 1 48 7 57 100,0 %

Sequence a B D  Total %

First 1 1 48 7 57 100,0 %

Total 1 1 48 7 57 100,0 %

Waiting time (months) basis date put on wl a B D  Total %

0-5 0 0 9 2 11 19,3 % 6-11 0 0 8 3 11 19,3 % 12-23 1 1 11 1 14 24,6 % 24+ 0 0 20 1 21 36,8 %

Total 1 1 48 7 57 100,0 %

Table 4.7(i) Active lung transplant waiting list as per December 31, from 2004 to 2008 - characteristics

Type of transplant 2004 2005 2006 2007 2008 2007/2008

Lung 589 668 758 849 846 -0,4 % Lung + kidney 1 3 2 3 5 66,7 % Lung + liver 2 3 5 4 8 100,0 % Lung + heart 54 64 59 55 57 3,6 %

Total 646 738 824 911 916 0,5 %

Table 4.7(ii) Active lung transplant waiting list as per December 31, 2008 - characteristics

Type of transplant a B D  Total %

Lung 60 74 535 177 846 92,4 % Lung + kidney 0 1 4 0 5 0,5 % Lung + liver 1 0 6 1 8 0,9 % Lung + heart 1 1 48 7 57 6,2 %

Total 62 76 593 185 916 100,0 %

Table 4.8(i) Active lung-only transplant waiting list, as per December 31, from 2004 to 2008 - characteristics

Blood Group 2004 2005 2006 2007 2008 2007/2008

A 207 247 281 322 333 3,4 % AB 13 16 25 21 10 -52,4 % B 71 74 78 84 76 -9,5 % O 298 331 374 422 427 1,2 %

Total 589 668 758 849 846 -0,4 %

% PRA current 2004 2005 2006 2007 2008 2007/2008

0-5 % 316 321 411 475 486 2,3 % 6-84 % 7 5 4 9 10 11,1 % 85-100 % 3 1 0 0 0 0,0 % Not reported 263 341 343 365 350 -4,1 %

Total 589 668 758 849 846 -0,4 %

45 Table 4.8(i) (Continued)

Sequence 2004 2005 2006 2007 2008 2007/2008

First 567 644 731 822 821 -0,1 % Repeat 22 24 27 27 25 -7,4 %

Total 589 668 758 849 846 -0,4 %

Waiting time (months) basis date put on wl 2004 2005 2006 2007 2008 2007/2008

0-5 240 252 264 289 265 -8,3 % 6-11 130 140 157 171 179 4,7 % 12-23 119 146 164 181 203 12,2 % 24+ 100 130 173 208 199 -4,3 %

Total 589 668 758 849 846 -0,4 %

Table 4.8(ii) Active lung-only transplant waiting list, as per December 31, 2008 - characteristics

Blood group a B D  Total %

A 24 24 214 71 333 39,4 % AB 1 2 4 3 10 1,2 % B 4 9 49 14 76 9,0 % O 31 39 268 89 427 50,5 %

Total 60 74 535 177 846 100,0 %

% PRA current a B D  Total %

0-5 % 14 5 323 144 486 57,4 % 6-84 % 0 1 7 2 10 1,2 % Not reported 46 68 205 31 350 41,4 %

Total 60 74 535 177 846 100,0 %

Sequence a B D  Total %

First 60 73 513 175 821 97,0 % Repeat 0 1 22 2 25 3,0 %

Total 60 74 535 177 846 100,0 %

Waiting time (months) basis date put on wl a B D  Total %

0-5 36 46 133 50 265 31,3 % 6-11 14 18 114 33 179 21,2 % 12-23 6 7 139 51 203 24,0 % 24+ 4 3 149 43 199 23,5 %

Total 60 74 535 177 846 100,0 %

Table 4.9(i) Heart transplants from 2004 to 2008 - characteristics

Deceased donor heart transplants

Type of transplant 2004 2005 2006 2007 2008 2007/2008

Heart-only 537 531 539 562 544 -3,2 % Heart + kidney 13 10 15 13 10 -23,1 % Heart + whole liver 3 1 1 2 3 50,0 % Heart + both lungs 18 21 30 21 23 9,5 % Heart + both lungs + kidney 0 0 0 0 1 -- % Heart + both lungs + whole liver 0 0 2 0 0 0,0 %

Total 571 563 587 598 581 -2,8 %

46 Table 4.9(i) (Continued)

Heart-only transplants

Blood group 2004 2005 2006 2007 2008 2007/2008

A 203 254 231 271 219 -19,2 % AB 49 35 41 39 37 -5,1 % B 58 71 85 68 81 19,1 % O 227 171 182 184 207 12,5 %

Total 537 531 539 562 544 -3,2 %

Waiting time (months) 2004 2005 2006 2007 2008 2007/2008

0-5 337 324 306 325 314 -3,4 % 6-11 113 94 104 107 105 -1,9 % 12-23 66 74 93 82 78 -4,9 % 24-59 19 39 35 45 46 2,2 % 60+ 2 0 1 3 1 -66,7 %

Total 537 531 539 562 544 -3,2 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 519 520 529 549 535 -2,6 % Repeat 18 11 10 13 9 -30,8 %

Total 537 531 539 562 544 -3,2 %

Table 4.9(ii) Heart transplants 2008 - characteristics

Deceased donor heart transplants

Type of transplant a B  D   Non-ET Total %

Heart-only 57 71 20 355 31 6 4 544 93,6 % Heart + kidney 2 2 0 6 0 0 0 10 1,7 % Heart + both lungs 3 1 0 18 1 0 0 23 4,0 % Heart + whole liver 0 1 0 2 0 0 0 3 0,5 % Heart + both lungs + kidney 0 0 0 1 0 0 0 1 0,2 %

Total 62 75 20 382 32 6 4 581 100,0 %

Heart-only transplants

Blood group a B  D   Non-ET Total %

A 21 31 7 144 16 0 0 219 40,3 % Ab 5 2 2 25 1 2 0 37 6,8 % B 10 6 7 51 3 2 2 81 14,9 % O 21 32 4 135 11 2 2 207 38,1 %

Total 57 71 20 355 31 6 4 544 100,0 %

Waiting time (months) a B  D   Non-ET Total %

0-5 37 48 14 197 14 1 3 314 57,7 % 6-11 10 20 5 60 10 0 0 105 19,3 % 12-23 7 2 1 62 3 2 1 78 14,3 % 24-59 3 1 0 35 4 3 0 46 8,5 % 60+ 0 0 0 1 0 0 0 1 0,2 %

Total 57 71 20 355 31 6 4 544 100,0 %

47 Table 4.9(ii) (Continued)

Sequence a B  D   Non-ET Total %

First 55 69 20 352 29 6 4 535 98,3 % Repeat 2 2 0 3 2 0 0 9 1,7 %

Total 57 71 20 355 31 6 4 544 100,0 %

Table 4.10(i) Heart + lung transplants from 2004 to 2008 - characteristics

Deceased donor heart + lung transplants

Type of transplant 2004 2005 2006 2007 2008 2007/2008

Heart + both Lungs 18 21 30 21 23 9,5 %

Total 18 21 30 21 23 9,5 %

Heart + lung transplants

Blood group 2004 2005 2006 2007 2008 2007/2008

A 8 15 11 10 10 0,0 % AB 1 1 2 1 4 300,0 % B 0 0 2 3 1 -66,7 % O 9 5 15 7 8 14,3 %

Total 18 21 30 21 23 9,5 %

Waiting time (months) 2004 2005 2006 2007 2008 2007/2008

0-5 6 17 15 8 14 75,0 % 6-11 4 2 3 2 2 0,0 % 12-23 2 1 5 7 2 -71,4 % 24-59 3 1 6 4 5 25,0 % 60+ 3 0 1 0 0 0,0 %

Total 18 21 30 21 23 9,5 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 18 21 30 21 23 9,5 %

Total 18 21 30 21 23 9,5 %

Table 4.10(ii) Heart + lung transplants 2008 - characteristics

Deceased donor heart + lung transplants

Type of transplant a B D  Total %

Heart + both lungs 3 1 18 1 23 100,0 %

Total 3 1 18 1 23 100,0 %

Heart + lung transplants

Blood group a B D  Total %

A 2 1 6 1 10 43,5 % AB 0 0 4 0 4 17,4 % B 0 0 1 0 1 4,3 % O 1 0 7 0 8 34,8 %

Total 3 1 18 1 23 100,0 %

48 Table 4.10(ii) (Continued)

Waiting time (months) a B D  Total %

0-5 0 0 13 1 14 60,9 % 6-11 0 1 1 0 2 8,7 % 12-23 0 0 2 0 2 8,7 % 24-59 3 0 2 0 5 21,7 %

Total 3 1 18 1 23 100,0 %

Sequence a B D  Total %

First 3 1 18 1 23 100,0 %

Total 3 1 18 1 23 100,0 %

Table 4.11(i) Lung transplants from 2004 to 2008 - characteristics

Deceased donor lung transplants

Type of transplant 2004 2005 2006 2007 2008 2007/2008

Single lung 99 103 120 89 82 -7,9 % Both lungs 316 345 338 410 419 2,2 % Single lung + kidney 0 0 0 1 0 -100,0 % Single lung + whole liver 0 0 1 0 0 0,0 % Both lungs + heart 18 21 30 21 23 9,5 % Both lungs + kidney 1 1 3 0 1 -- Both lungs + whole liver 2 1 2 4 1 -75,0 % Both lungs + heart + kidney 0 0 0 0 1 -- Both lungs + heart + whole liver 0 0 2 0 0 0,0 %

Total 436 471 496 525 527 0,4 %

Lung-only transplant (including single and both lungs)

Blood group 2004 2005 2006 2007 2008 2007/2008

A 174 192 206 229 219 -4,4 % AB 33 33 28 36 24 -33,3 % B 43 62 61 59 61 3,4 % O 165 161 163 175 197 12,6 %

Total 415 448 458 499 501 0,4 %

Waiting time (months) 2004 2005 2006 2007 2008 2007/2008

0-5 202 236 225 235 240 2,1 % 6-11 89 95 102 112 107 -4,5 % 12-23 84 68 79 89 89 0,0 % 24-59 38 48 46 58 53 -8,6 % 60+ 2 1 6 5 12 140,0 %

Total 415 448 458 499 501 0,4 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 396 430 436 459 474 3,3 % Repeat 19 18 22 40 27 -32,5 %

Total 415 448 458 499 501 0,4 %

49 Table 4.11(ii) Lung transplants 2008 - characteristics

Deceased donor lung transplants

Type of transplant a B D  Total %

Both lungs 103 65 210 41 419 79,5 % Single lung 13 15 40 14 82 15,6 % Both lungs + heart 3 1 18 1 23 4,4 % Both lungs + whole liver 0 1 0 0 1 0,2 % Both lungs + kidney 0 0 1 0 1 0,2 % Both lungs + heart + kidney 0 0 1 0 1 0,2 %

Total 119 82 270 56 527 100,0 %

Lung-only transplants (including single and both lungs)

Blood group a B D  Total %

A 40 37 114 28 219 43,7 % AB 11 2 8 3 24 4,8 % B 16 3 36 6 61 12,2 % O 49 38 92 18 197 39,3 %

Total 116 80 250 55 501 100,0 %

Waiting time (months) a B D  Total %

0-5 80 42 101 17 240 47,9 % 6-11 14 25 51 17 107 21,4 % 12-23 20 10 46 13 89 17,8 % 24-59 2 3 40 8 53 10,6 % 60+ 0 0 12 0 12 2,4 %

Total 116 80 250 55 501 100,0 %

Sequence a B D  Total %

First 112 78 230 54 474 94,6 % Repeat 4 2 20 1 27 5,4 %

Total 116 80 250 55 501 100,0 %

1200 Figure 4.1 Dynamics of the Eurotransplant heart 1000 waiting list and transplants between 1991 and 2008 800

600

400

200

0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Active waiting list 499 552 672 723 709 744 744 721 609 489 424 423 568 728 882 920 959 1007

Heart transplants 806 753 773 696 732 759 782 759 708 623 596 580 570 553 542 555 577 557

1000 Figure 4.2 Dynamics of the 900 Eurotransplant heart + 800 lung waiting list and heart 700 + lung transplants and 600 Eurotransplant lung 500 waiting list and lung 400 transplants between 1991 300 200 and 2008 100 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Lung waiting list 90 141 203 227 224 204 216 224 350 377 430 462 517 592 674 765 856 859 Heart+Lung waiting list 48 48 49 71 79 71 66 60 46 42 43 43 45 54 64 59 55 57 Heart+Lung transplants 24 32 28 43 42 34 43 20 28 20 21 24 23 18 21 32 21 24 Lung transplants 71 109 119 138 125 154 155 228 239 258 272 358 382 418 450 464 504 503

50 5. Liver and intestine: donation, waiting lists and tranplants

Table 5.1(i) Deceased donor livers in Eurotransplant from 2004 to 2008

Donors

Year of registration 2004 2005 2006 2007 2008 2007/2008

Deceased donors 2071 2249 2299 2411 2233 -7,4 % Non-liver donors 506 494 423 422 361 -14,5 % Deceased liver donors 1565 1755 1876 1989 1872 -5,9 % Liver donors not used 373 453 481 420 322 -23,3 % One split used 7 3 2 3 5 66,7 % Both splits used 71 59 45 53 56 5,7 % Whole liver used 1114 1240 1348 1513 1489 -1,6 % Total liver donors used 1192 1302 1395 1569 1550 -1,2 %

Donor procedures

Year of registration 2004 2005 2006 2007 2008 2007/2008

Whole liver procedure 1485 1686 1827 1932 1808 -6,4 % Split liver procedure 80 68 49 57 64 12,3 %

Total 1565 1754 1876 1989 1872 -5,9 %

Whole livers

Year of registration 2004 2005 2006 2007 2008 2007/2008

Reported 1485 1686 1827 1932 1808 -6,4 % Offered 1476 1670 1793 1901 1799 -5,4 % Accepted 1384 1543 1682 1835 1739 -5,2 % Transplanted 1114 1240 1348 1513 1489 -1,6 %

Split livers

Year of registration 2004 2005 2006 2007 2008 2007/2008

Available split livers 160 136 98 114 128 12,3 % Split liver not used 11 15 6 5 11 120,0 % Split liver transplanted 149 121 92 109 117 7,3 %

Table 5.1(ii) Deceased donor livers in Eurotransplant in 2008

Donors

Donor country a B  D L   Total ET Non-ET Total % all donors

Deceased donors 179 299 84 1226 9 240 39 2076 157 2233 100,0 % Non-liver donors 31 24 5 90 0 69 2 221 140 361 16,0 % Deceased liver donors 148 275 79 1136 9 171 37 1855 17 1872 84,0 % Liver donors not used 30 68 13 160 0 36 8 315 7 322 14,0 % One split used 0 1 0 2 0 1 0 4 1 5 0,0 % Both splits used 4 14 3 31 0 4 0 56 0 56 3,0 % Whole liver used 114 192 63 943 9 130 29 1480 9 1489 67,0 % Total liver donors used 118 207 66 976 9 135 29 1540 10 1550 69,0 %

51 Table 5.1(ii) (Continued)

Donor procedures

Donor country a B  D L   Total ET Non-ET Total %

Whole liver procedure 143 258 76 1103 9 166 37 1792 16 1808 97,0 % Split liver procedure 5 17 3 33 0 5 0 63 1 64 3,0 %

Total 148 275 79 1136 9 171 37 1855 17 1872 100,0 %

Whole livers

Donor country a B  D L   Total ET Non-ET Total % reported

Reported 143 258 76 1103 9 166 37 1792 16 1808 100,0 % Offered 142 254 76 1102 9 164 37 1784 15 1799 100,0 % Accepted 138 239 75 1082 9 150 36 1729 10 1739 96,0 % Transplanted 114 192 63 943 9 130 29 1480 9 1489 82,0 %

Split livers

Donor country a B  D L   Total ET Non-ET Total %

Available split livers 10 34 6 66 0 10 0 126 2 128 100,0 % Split liver not used 2 5 0 2 0 1 0 10 1 11 9,0 % Split liver transplanted 8 29 6 64 0 9 0 116 1 117 91,0 %

Table 5.2(i) Active liver transplant waiting list, as per December 31, from 2004 to 2008 - characteristics

Type of transplant 2004 2005 2006 2007 2008 2007/2008

Liver 1959 2066 2249 2351 2354 0,1 % Liver + heart 0 0 1 2 2 0,0 % Liver + kidney 70 60 62 67 72 7,5 % Liver + lung 2 3 5 4 8 100,0 % Liver + pancreas 2 4 1 5 4 -20,0 % Liver + kidney + pancreas 2 1 1 0 2

Total 2035 2134 2319 2429 2442 0,5 %

Table 5.2(ii) Active liver transplant waiting list, as per December 31, 2008 - characteristics

Type of transplant a B  D   Total %

Liver 110 179 61 1875 116 13 2354 96,4 % Liver + heart 0 0 0 2 0 0 2 0,1 % Liver + kidney 2 9 0 60 1 0 72 2,9 % Liver + lung 1 0 0 6 1 0 8 0,3 % Liver + pancreas 0 0 0 4 0 0 4 0,2 % Liver + kidney + pancreas 0 1 0 1 0 0 2 0,1 %

Total 113 189 61 1948 118 13 2442 100,0 %

Table 5.3(i) Active liver-only transplant waiting list as per December 31, from 2004 to 2008 - characteristics

Blood group 2004 2005 2006 2007 2008 2007/2008

A 869 863 909 988 944 -4,5 % AB 58 53 59 40 46 15,0 % B 242 273 282 275 267 -2,9 % O 790 877 999 1048 1097 4,7 %

Total 1959 2066 2249 2351 2354 0,1 %

52 Table 5.3(i) (Continued)

% PRA current 2004 2005 2006 2007 2008 2007/2008

0-5 % 512 561 594 613 620 1,1 % 6-84 % 27 26 34 43 42 -2,3 % 85-100 % 1 3 0 0 2 -- Not reported 1419 1476 1621 1695 1690 -0,3 %

Total 1959 2066 2249 2351 2354 0,1 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 1847 1955 2120 2234 2233 -0,0 % Repeat 112 111 129 117 121 3,4 %

Total 1959 2066 2249 2351 2354 0,1 %

Waiting time (months) basis date put on wl 2004 2005 2006 2007 2008 2007/2008

0-5 737 711 783 690 665 -3,6 % 6-11 468 382 416 398 363 -8,8 % 12-23 531 542 458 551 462 -16,2 % 24+ 223 431 592 712 864 21,3 %

Total 1959 2066 2249 2351 2354 0,1 %

Table 5.3(ii) Active liver-only transplant waiting list as per December 31, 2008 - characteristics

Blood group a B  D   Total %

A 38 61 26 788 26 5 944 40,1 % Ab 7 5 3 27 3 1 46 2,0 % B 16 14 11 218 6 2 267 11,3 % O 49 99 21 842 81 5 1097 46,6 %

Total 110 179 61 1875 116 13 2354 100,0 %

% PRA current a B  D   Total %

0-5 % 23 14 35 479 69 0 620 26,3 % 6-84 % 2 6 7 22 5 0 42 1,8 % 85-100 % 0 0 0 2 0 0 2 0,1 % not reported 85 159 19 1372 42 13 1690 71,8 %

Total 110 179 61 1875 116 13 2354 100,0 %

Sequence a b  d   Total %

First 99 165 61 1787 108 13 2233 94,9 % Repeat 11 14 0 88 8 0 121 5,1 %

Total 110 179 61 1875 116 13 2354 100,0 %

Waiting time (months) basis date put on wl a B  D   Total %

0-5 55 82 28 453 37 10 665 28,2 % 6-11 27 26 8 280 20 2 363 15,4 % 12-23 17 33 25 367 19 1 462 19,6 % 24+ 11 38 0 775 40 0 864 36,7 %

Total 110 179 61 1875 116 13 2354 100,0 %

53 Table 5.4(i) Liver transplants from 2004 to 2008 - characteristics

Deceased donor liver transplants

Type of transplant 2004 2005 2006 2007 2008 2007/2008

Split liver 146 119 90 105 113 7,6 % Whole liver 1058 1196 1273 1439 1405 -2,4 % Split liver + kidney 5 2 2 4 4 0,0 % Whole liver + kidney 42 41 61 64 73 14,1 % Whole liver + kidney en bloc 0 1 1 1 2 100,0 % Whole liver + pancreas 6 2 2 5 5 0,0 % Whole liver + heart 3 1 1 2 3 50,0 % Whole liver + lung 0 0 1 0 0 0,0 % Whole liver + both lungs 2 1 2 4 1 -75,0 % Whole liver + kidney + pancreas 0 1 1 1 0 -100,0 % Whole liver + heart + both lungs 0 0 2 0 0 0,0 %

Total 1262 1364 1436 1625 1606 -1,2 %

Liver-only transplant (whole and split)

Blood group 2004 2005 2006 2007 2008 2007/2008

A 489 579 603 656 655 -0,2 % AB 99 114 90 131 103 -21,4 % B 161 170 208 219 192 -12,3 % O 455 452 462 538 568 5,6 %

Total 1204 1315 1363 1544 1518 -1,7 %

Waiting time (months) 2004 2005 2006 2007 2008 2007/2008

0-5 708 759 801 1057 999 -5,5 % 6-11 225 212 221 194 238 22,7 % 12-23 222 228 198 185 160 -13,5 % 24-59 46 114 138 98 107 9,2 % 60+ 3 2 5 10 14 40,0 %

Total 1204 1315 1363 1544 1518 -1,7 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 1049 1127 1191 1351 1336 -1,1 % Repeat 155 188 172 193 182 -5,7 %

Total 1204 1315 1363 1544 1518 -1,7 %

Table 5.4(ii) Liver transplants 2008 - characteristics

Deceased donor liver transplants

Type of transplant a B  D   Non-ET Total %

Split liver 1 17 0 86 8 0 1 113 7,0 % Whole liver 104 186 61 915 116 22 1 1405 87,5 % Split liver + kidney 0 1 0 3 0 0 0 4 0,2 % Whole liver + kidney 7 10 3 49 4 0 0 73 4,5 % Whole liver + kidney en bloc 0 0 0 2 0 0 0 2 0,1 % Whole liver + pancreas 0 1 0 3 1 0 0 5 0,3 % Whole liver + heart 0 1 0 2 0 0 0 3 0,2 % Whole liver + both lungs 0 1 0 0 0 0 0 1 0,1 %

Total 112 217 64 1060 129 22 2 1606 100,0 %

54 Table 5.4(ii) (Continued)

Liver-only transplants (whole and split)

Blood group a B  D   Non-ET Total %

A 46 85 20 442 52 10 0 655 43,1 % Ab 10 9 4 70 7 2 1 103 6,8 % B 12 18 14 131 11 6 0 192 12,6 % O 37 91 23 358 54 4 1 568 37,4 %

Total 105 203 61 1001 124 22 2 1518 100,0 %

Waiting time (months) a B  D   Non-ET Total %

0-5 56 151 47 655 71 17 2 999 65,8 % 6-11 22 31 11 146 26 2 0 238 15,7 % 12-23 24 18 3 101 12 2 0 160 10,5 % 24-59 3 3 0 86 14 1 0 107 7,0 % 60+ 0 0 0 13 1 0 0 14 0,9 %

Total 105 203 61 1001 124 22 2 1518 100,0 %

Sequence a B  D   Non-ET Total %

First 96 185 59 869 105 20 2 1336 88,0 % Repeat 9 18 2 132 19 2 0 182 12,0 %

Total 105 203 61 1001 124 22 2 1518 100,0 %

Table 5.5(i) Living donor liver transplants - liver-only - from 2004 to 2008

Liver-only 2004 2005 2006 2007 2008 2007/2008

Domino 8 15 10 10 7 -30,0 % Non-related 15 15 20 13 9 -30,8 % Related 83 91 86 78 66 -15,4 %

Total 106 121 116 101 82 -18,8 %

Related 2004 2005 2006 2007 2008 2007/2008

Brother / sister 8 14 11 10 6 -40,0 % Father 17 23 21 18 21 16,7 % Mother 23 19 19 27 24 -11,1 % Son / daughter 29 30 28 15 10 -33,3 % Grand father / -mother 1 2 2 1 0 -100,0 % Nephew / niece 5 2 2 4 2 -50,0 % Uncle / aunt 0 0 2 1 3 200,0 % Blood related : nos* 0 1 1 2 0 -100,0 %

Total 83 91 86 78 66 -15,4 %

Non-related 2004 2005 2006 2007 2008 2007/2008

Friend 0 0 0 1 1 0,0 % Spouse / partner 10 11 11 9 4 -55,6 % Not blood related family 3 2 3 3 3 0,0 % Not blood related: nos* 2 2 6 0 1 --

Total 15 15 20 13 9 -30,8 %

*NOS Not otherwise specified

55 Table 5.5(ii) Living donor liver transplants - liver-only - 2008

Liver-only a B  D  Total %

Related 4 10 0 50 2 66 80,5 % Non-related 0 3 1 5 0 9 11,0 % Domino 0 0 0 7 0 7 8,5 %

Total 4 13 1 62 2 82 100,0 %

Related a B  D  Total %

Brother / sister 0 1 0 5 0 6 9,1 % Father 2 3 0 15 1 21 31,8 % Mother 2 5 0 16 1 24 36,4 % Son / daughter 0 0 0 10 0 10 15,2 % Uncle / aunt 0 1 0 2 0 3 4,5 % Nephew / niece 0 0 0 2 0 2 3,0 %

Total 4 10 0 50 2 66 100,0 %

Non-related a B  D  Total %

Friend 0 1 0 0 0 1 11,1 % Spouse / partner 0 0 1 3 0 4 44,4 % Not blood related family 0 2 0 2 0 4 44,4 %

Total 0 3 1 5 0 9 100,0 %

Figure 5.1 Dynamics of the Eurotransplant liver waiting list and liver transplants between 1991 and 2008

3000

2500

2000

1500

1000

500

0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Liver waiting list 229 253 203 212 263 327 374 492 593 803 1093 1366 1714 2035 2134 2319 2429 2442 Living donor transplants* 5 15 14 24 25 22 41 38 64 116 124 129 133 106 121 116 101 82 Deceased donor transplants 710 765 878 892 944 1032 1097 1071 1132 1168 1112 1136 1264 1262 1364 1436 1625 1606

*including domino transplants

56 Intestine transplants 2008

On January 1, 2008, 25 patients were on the waiting list for an intestinal transplant (15 in Germany, 7 in Belgium, 1 in Austria, 2 in the Netherlands). During the year 2008, 17 patients were registered for either an intestinal transplant (N=10) or for a combined intestinal transplant (N=7). As per December 31, 2008, 21* patients were awaiting either an isolated intestinal transplant (N=13) or in combination with another organ (N=8).

Table 5.6 Number of intestinal transplants performed in 2008

Country Total

Austria 1

Belgium 2

Croatia 1

Germany 11

Netherlands 2

Total 17

Nine transplants concerned isolated intestine transplants and eight concerned combined intestine transplants. In 2007, three isolated intestine transplants were performed and eight combined intestine transplants.

Two patients deceased while awaiting a transplant. Two patients were removed from the waiting list.

* Urgency status of patients on the waiting list as per December 31, 2008: Intestine-only: 8 patients registered T(transplantable), 5 patients registered NT(non transplantable) Combined: 4 patients registered T, 4 patients registered NT

57 6. Pancreas and islets: donation, waiting lists and transplants

Table 6.1(i) Deceased donors / pancreas in Eurotransplant from 2004 to 2008

Donors

Year of registration 2004 2005 2006 2007 2008 2007/2008

All donors 2071 2249 2299 2411 2233 -7,4 % Non-pancreas donors 1149 1314 1311 1373 1312 -4,4 % Pancreas donors 922 935 988 1038 921 -11,3 % Pancreas donors not used 576 630 743 783 664 -15,2 % Pancreatic islet donors used 76 63 16 40 38 -5,0 % Whole pancreas donors used 270 242 229 215 219 1,9 % Total pancreas donors used 346 305 245 255 257 0,8 %

Pancreas

Year of registration 2004 2005 2006 2007 2008 2007/2008

Reported 922 933 987 1038 921 -11,3 % Offered 888 889 951 981 880 -10,3 % Accepted 607 600 571 548 551 0,5 % Transplanted 346 305 245 255 257 0,8 %

Table 6.1(ii) Deceased donors / pancreas in Eurotransplant in 2008

Donors

Deceased donors a B  D L   Total ET Non-ET Total % all donors

All donors 179 299 84 1226 9 240 39 2076 157 2233 100,0 % Non-pancreas donors 114 96 49 798 3 79 21 1160 152 1312 59,0 % Pancreas donors 65 203 35 428 6 161 18 916 5 921 41,0 % Pancreas donors not used 35 159 18 295 4 132 16 659 5 664 30,0 % Pancreatic islet donors used 1 18 0 6 0 13 0 38 0 38 2,0 % Whole pancreas donors used 29 26 17 127 2 16 2 219 0 219 10,0 % Total pancreas donors used 30 44 17 133 2 29 2 257 0 257 12,0 %

Pancreas

Donor country a B  D L   Total ET Non-ET Total % reported

Reported 65 203 35 428 6 161 18 916 5 921 100,0 % Offered 65 193 34 404 5 156 18 875 5 880 96,0 % Accepted 50 129 22 256 4 82 7 550 1 551 60,0 % Transplanted 30 44 17 133 2 29 2 257 0 257 28,0 %

Table 6.2(i) Active pancreas transplant waiting list as per December 31, from 2004 to 2008 - characteristics

Type of transplant 2004 2005 2006 2007 2008 2007/2008

Pancreas 74 59 48 43 55 27,9 % Pancreas + liver 2 4 1 5 4 -20,0 % Pancreas + kidney 203 217 242 304 300 -1,3 % Pancreas + liver + kidney 2 1 1 0 2

Total 281 281 292 352 361 2,6 %

58 Table 6.2(ii) Active pancreas transplant waiting list as per December 31, 2008 - characteristics

Type of transplant a B  D   Total %

Pancreas 7 3 0 31 14 0 55 15,2 % Pancreas + liver 0 0 0 4 0 0 4 1,1 % Pancreas + kidney 30 23 3 227 16 1 300 83,1 % Pancreas + liver + kidney 0 1 0 1 0 0 2 0,6 %

Total 37 27 3 263 30 1 361 100,0 %

Table 6.3a(i) Active pancreas-only transplant waiting list as per December 31, from 2004 to 2008 - characteristics

blood group 2004 2005 2006 2007 2008 2007/2008

A 34 27 19 24 23 -4,2 % AB 0 2 2 2 4 100,0 % B 3 8 8 3 7 133,3 % O 37 22 19 14 21 50,0 %

Total 74 59 48 43 55 27,9 %

% PRA current 2004 2005 2006 2007 2008 2007/2008

0-5 % 61 49 44 39 48 23,1 % 6-84 % 3 5 4 4 7 75,0 % 85-100 % 1 0 0 0 0 0,0 % Not reported 9 5 0 0 0 0,0 %

Total 74 59 48 43 55 27,9 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 45 30 23 20 26 30,0 % Repeat 29 29 25 23 29 26,1 %

Total 74 59 48 43 55 27,9 %

Waiting time (months) basis date put on wl 2004 2005 2006 2007 2008 2007/2008

0-5 25 16 7 8 13 62,5 % 6-11 8 17 9 9 11 22,2 % 12-23 15 13 20 7 5 -28,6 % 24+ 26 13 12 19 26 36,8 %

Total 74 59 48 43 55 27,9 %

Table 6.3a(ii) Active pancreas-only transplant waiting list as per December 31, 2008 - characteristics

Blood group a B D  Total %

A 4 1 10 8 23 41,8 % AB 0 0 4 0 4 7,3 % B 1 0 4 2 7 12,7 % O 2 2 13 4 21 38,2 %

Total 7 3 31 14 55 100,0 %

% PRA current a B D  Total %

0-5 % 7 2 25 14 48 87,3 % 6-84 % 0 1 6 0 7 12,7 %

Total 7 3 31 14 55 100,0 %

59 Table 6.3a(ii) (Continued)

Sequence a B D  Total %

First 2 1 16 7 26 47,3 % Repeat 5 2 15 7 29 52,7 %

Total 7 3 31 14 55 100,0 %

Waiting time (months) basis date put on wl a B D  Total %

0-5 2 0 8 3 13 23,6 % 6-11 0 1 7 3 11 20,0 % 12-23 0 1 4 0 5 9,1 % 24+ 5 1 12 8 26 47,3 %

Total 7 3 31 14 55 100,0 %

Table 6.3b(i) Active kidney + pancreas transplant waiting list as per December 31, from 2004 to 2008 - characteristics

Blood group 2004 2005 2006 2007 2008 2007/2008

A 67 91 97 127 116 -8,7 % AB 1 2 3 9 10 11,1 % B 36 35 40 48 50 4,2 % O 99 89 102 120 124 3,3 %

Total 203 217 242 304 300 -1,3 %

% PRA current 2004 2005 2006 2007 2008 2007/2008

0-5 % 179 197 224 276 263 -4,7 % 6-84 % 14 16 15 21 29 38,1 % 85-100 % 2 0 2 5 8 60,0 % Not reported 8 4 1 2 0 -100,0 %

Total 203 217 242 304 300 -1,3 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 193 200 232 276 273 -1,1 % Repeat 10 17 10 28 27 -3,6 %

Total 203 217 242 304 300 -1,3 %

Waiting time (months) basis date put on wl 2004 2005 2006 2007 2008 2007/2008

0-5 105 85 76 90 72 -20,0 % 6-11 57 84 79 87 91 4,6 % 12-23 26 32 69 94 93 -1,1 % 24+ 15 16 16 33 44 33,3 % Unknown 0 0 2 0 0 0,0 %

Total 203 217 242 304 300 -1,3 %

Table 6.3b(ii) Active kidney + pancreas transplant waiting list as per December 31, 2008 - characteristics

Blood group a B  D   Total %

A 11 10 0 91 4 0 116 38,7 % Ab 1 1 0 8 0 0 10 3,3 % B 6 4 0 38 2 0 50 16,7 % O 12 8 3 90 10 1 124 41,3 %

Total 30 23 3 227 16 1 300 100,0 %

60 Table 6.3b(ii) (Continued)

% PRA current a B  D   Total %

0-5 % 20 20 3 203 16 1 263 87,7 % 6-84 % 9 1 0 19 0 0 29 9,7 % 85-100 % 1 2 0 5 0 0 8 2,7 %

Total 30 23 3 227 16 1 300 100,0 %

Sequence a B  D   Total %

First 20 22 3 211 16 1 273 91,0 % Repeat 10 1 0 16 0 0 27 9,0 %

Total 30 23 3 227 16 1 300 100,0 %

Waiting time (months) basis date put on wl a B  D   Total %

0-5 14 4 2 50 2 0 72 24,0 % 6-11 10 6 0 71 4 0 91 30,3 % 12-23 5 6 1 75 5 1 93 31,0 % 24+ 1 7 0 31 5 0 44 14,7 %

Total 30 23 3 227 16 1 300 100,0 %

Table 6.4a(i) Pancreas transplants from 2004 to 2008 - characteristics

Deceased donor pancreas transplants

Type of transplant 2004 2005 2006 2007 2008 2007/2008

Islets 23 17 5 15 17 13,3 % Islets + kidney 4 2 0 0 0 0,0 % Pancreas 34 31 31 29 20 -31,0 % Pancreas + both kidneys 1 0 0 0 0 0,0 % Pancreas + kidney 229 209 195 180 194 7,8 % Pancreas + kidney + whole liver 0 1 1 1 0 -100,0 % Pancreas + whole liver 6 2 2 5 5 0,0 %

Total 297 262 234 230 236 2,6 %

Pancreas-only (deceased donor) transplants (whole)

Blood group 2004 2005 2006 2007 2008 2007/2008

A 9 12 11 15 11 -26,7 % AB 2 1 3 0 2 -- B 3 1 4 5 1 -80,0 % O 20 17 13 9 6 -33,3 %

Total 34 31 31 29 20 -31,0 %

Waiting time (months) 2004 2005 2006 2007 2008 2007/2008

0-5 11 6 10 12 4 -66,7 % 6-11 11 10 9 3 4 33,3 % 12-23 8 10 9 12 8 -33,3 % 24-59 4 5 2 2 4 100,0 % 60 + 0 0 1 0 0 0,0 %

Total 34 31 31 29 20 -31,0 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 15 10 13 11 8 -27,3 % Repeat 19 21 18 18 12 -33,3 %

Total 34 31 31 29 20 -31,0 %

61 Table 6.4a(ii) Pancreas transplants 2008 - characteristics

Deceased donor pancreas transplants

Type of transplant a B  D  Total %

Pancreas 3 2 0 13 2 20 8,5 % Islets 0 12 0 2 3 17 7,2 % Pancreas + kidney 31 16 14 121 12 194 82,2 % Pancreas + liver 0 1 0 3 1 5 2,1 %

Total 34 31 14 139 18 236 100,0 %

Pancreas-only (deceased donor) transplants (whole)

Blood group a B  D  Total %

A 2 1 0 8 0 11 55,0 % AB 1 0 0 1 0 2 10,0 % B 0 0 0 0 1 1 5,0 % O 0 1 0 4 1 6 30,0 %

Total 3 2 0 13 2 20 100,0 %

Waiting time (months) a B  D  Total %

0-5 1 0 0 2 1 4 20,0 % 6-11 0 2 0 2 0 4 20,0 % 12-23 2 0 0 6 0 8 40,0 % 24-59 0 0 0 3 1 4 20,0 %

Total 3 2 0 13 2 20 100,0 %

Sequence a B  D  Total %

First 0 2 0 5 1 8 40,0 % Repeat 3 0 0 8 1 12 60,0 %

Total 3 2 0 13 2 20 100,0 %

Table 6.4b(i) Number of pancreas islet transplants from 2004 to 2008

Year 2004 2005 2006 2007 2008 2007/2008

Recipients transplanted 20 12 3 8 9 12,5 % Number of transplants 27 19 5 15 17 13,3 % Number of donors used 76 61 18 40 37 -7,5 %

Table 6.4b(ii) Number of pancreas islet transplants in 2008

Group center BBCTP GDRTP GTUTP NLBTP Total

Recipients transplanted 5 1 1 2 9 Number of transplants 12 1 1 3 17 Number of donors used 32 1 1 3 37

Table 6.4c(i) Pancreas transplants from 2004 to 2008 - characteristics

Whole pancreas + kidney (deceased donor) transplants

blood group 2004 2005 2006 2007 2008 2007/2008

A 97 86 81 75 90 20,0 % AB 13 10 11 11 12 9,1 % B 23 30 26 21 12 -42,9 % O 96 83 77 73 80 9,6 %

Total 229 209 195 180 194 7,8 %

62 Table 6.4c(i) (Continued)

Waiting time (months) 2004 2005 2006 2007 2008 2007/2008

0-5 68 50 35 32 34 6,3 % 6-11 82 84 70 29 36 24,1 % 12-23 62 59 76 97 83 -14,4 % 24-59 16 14 14 20 38 90,0 % 60+ 1 2 0 2 3 50,0 %

Total 229 209 195 180 194 7,8 %

Sequence 2004 2005 2006 2007 2008 2007/2008

First 220 202 181 179 187 4,5 % Repeat 9 7 14 1 7 600,0 %

Total 229 209 195 180 194 7,8 %

Table 6.4c(ii) Pancreas transplants 2008 - characteristics

Whole pancreas + kidney (deceased donor) transplants

Blood group a B  D  Total %

A 10 8 7 57 8 90 46,4 % AB 3 1 1 6 1 12 6,2 % B 2 1 2 7 0 12 6,2 % O 16 6 4 51 3 80 41,2 %

Total 31 16 14 121 12 194 100,0 %

Waiting time (months) a B  D  Total %

0-5 10 3 9 12 0 34 17,5 % 6-11 12 6 3 12 3 36 18,6 % 12-23 4 5 2 68 4 83 42,8 % 24-59 3 2 0 28 5 38 19,6 % 60+ 2 0 0 1 0 3 1,5 %

Total 31 16 14 121 12 194 100,0 %

Sequence a B  D  Total %

First 31 16 14 114 12 187 96,4 % Repeat 0 0 0 7 0 7 3,6 %

Total 31 16 14 121 12 194 100,0 %

Figure 6.1 Dynamics of the Eurotransplant pancreas+kidney and islet+kidney waiting list, pancreas+kidney, islet+kidney, pancreas- and islet-only transplants between 1991 and 2008

350

300

250

200

150

100

50

0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Islet+Kidney & Pancreas+Kidney waiting list 120 141 112 98 85 110 127 155 193 195 144 219 176 203 217 242 304 300 Pancreas+Kidney transplants 70 62 92 87 98 131 189 230 282 302 264 208 247 229 209 195 180 194 Islets+Kidney transplant 0 0 0 1 5 9 13 4 4 4 5 4 3 4 2 0 0 0 Pancreas transplants 4 4 2 3 1 8 15 17 13 16 19 39 35 34 31 31 29 20 Islet transplants 0 1 6 5 15 6 9 7 2 9 18 46 33 23 17 5 15 17

63 7. Histocompatibility Testing

I.I.N. Doxiadis, PhD and F.H.J. Claas, PhD, Eurotransplant Reference Laboratory, Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands

7.1 Introduction An ongoing task of the Eurotransplant Reference Laboratory (ETRL) is the improvement and maintenance of the high quality of HLA typing, screening for transplantation relevant antibodies and crossmatching within Eurotransplant (ET) and its affiliated centers. This task is addressed by organizing schemes for External Proficiency Testing exercises (EPT) for the collaborating Tissue Typing Centers (TTC). Furthermore, the ETRL initiates studies and promotes discussions for possible new recommendations with the help of the Tissue Typing Advisory Committee (TTAC). In addition, for almost 30 years the ETRL has addressed the problem of highly sensitized patients, by organizing and promoting the Acceptable Mismatch (AM) program within and outside ET. Finally, visits to the affiliated TTC belong to its duties. For example in 2008 the Tissue Typing Center of Rijeka in Croatia was visited and helped for completing the EFI accreditation procedure. In September 2008 Rijeka received the EFI accreditation. Finally, the ETRL provides 24 hours a day, 7 days a week duty for all transplantation relevant immunological aspects for all patients within ET.

7.2 Eurotransplant External Proficiency Testing Schemes The results of the EPT Exercises, applied in 2008, to determine the individual performance of the TTC’s are reported below:

7.2.1 External Proficiency Testing on HLA typing Each participating laboratory received 12 blood samples for typing and was asked to report the results prior to a certain deadline. For the analysis of the results the typing performed by the ETRL was taken as correct, as proposed by the External Proficiency Testing Committee of the European Federation for Immunogenetics (www.efiweb.org). The participants had to report their results on the basis of matching determinants, a translation of molecular typing results to serological equivalents, which are used in the matching algorithm and screening results. No discrepancy was seen for the HLA loci A, B, DR.

In the period 2008, no participant used the complement dependent cytotoxicity (CDC) for typing as the only method for typing. Twelve out of the 56 participants used molecular methods only for HLA-A, B typing while the remaining 44 used a combination of molecular and CDC typing. For HLA-DR typing the number of molecular typing only was 34 while the remaining 22 used both methods. These results indicate that laboratories affiliated to ET as well as to other organ exchange organizations use the results of the serological typing (expression of antigens in the cell surface) to evaluate the crossmatches.

7.2.2 External Proficiency Testing on crossmatching The participants of this External Proficiency Testing Exercise were asked to perform crossmatches using the cells provided for the Proficiency Testing Exercise on the sera of 4 different patients on the kidney waiting list from ET selected by the ETRL. The TTC applied the local crossmatch techniques, CDC, using dithiothreitol (DTT) to destroy IgM specific antibodies to simulate the day-to-day practice. The TTC were free to use unseparated peripheral blood cells, separated T and/or B cells but they had to report a final crossmatch result as it is done for organ donor procedures. Therefore, the average number of reports per category varies (table 7.1). In total 48 sera had to be crossmatched per participant. For the centers not receiving the sera of the patients on the waiting list, i.e. German centers performing patient histocompatibility work only, Scandia Transplant laboratories, and centers from other organ exchange organizations such as the Czech Republic, 8 sera were selected by the ETRL and sent to the participants. These participants could report 48 crossmatches in total. The target cells and the respective results are presented in table 7.1.

64 Table 7.1 Report of the crossmatch results (DTT = dithiothreitol)

DC (N=31) RC / Others (N=28) DTT N Discr. % N Discr % (-) 1083 55 5,1 599 25 4,2 Unseparated (+) 1076 63 5,9 587 22 3,7 (-) 790 36 4,6 689 37 5,4 T cells (+) 673 35 5,2 479 27 5,6 (-) 760 47 6,2 640 34 5,3 B cells (+) 632 46 7,3 504 26 5,2 (-) 1320 54 4,1 1185 36 3,0 Final results (+) 1286 52 4,0 1081 26 2,4

The difference in the % of discrepancies between the 2 groups of participants can be attributed to the sera used. While ET participants used sera of patients on the waiting list, the non-ET participants received sera from multiparous women and usual controls.

7.2.3 External Proficiency Testing Exercise on screening

In 2008 the scheme of the EPT Exercise on screening for HLA specific antibodies comprised 2 shipments of 6 sera. The HLA typing of the serum donor, the immunizing partner and of one of the children is known in almost all instances, and is reported to the participants beforehand. The ETRL received results from 64 participants cooperating with solid organ transplant centers within and outside ET. Currently, the methods for screening for HLA specific antibodies are evolving rapidly, the reason why standardized analyses cannot be done yet. In total 732 reports were received, a lower number compared to last year, mainly because of a centralization of laboratories in Belgium. The reported % PRA value remains unreliable. The virtual PRA value http://etrl.eurotransplant.nl/cms/index.php) is not yet fully adopted by the participants. From the 64 participants, 14 reported CDC results only (22%). The majority applied, in addition to CDC, a solid phase assay (SPA) being ELISA or Luminex based. In 10 out of the 12 sera HLA specificities reached the 75% consensus which can be seen as an increase in quality, a trend observed already in 2007. One point of concern is, however, the large number of specificities reported by single centers, when the Luminex based single antigen bead assay is used. Even HLA antigens expressed by the serum donor were reported positive (!). For this reason the 95% consensus for negative reports was introduced. If 95% of the participants report that a given specificity is negative then this result is regarded as the correct answer. In total 285 specificities were reported, 175 out of these 285 were reported by participants using Luminex single antigen beads assays only.

7.3 Program for the highly sensitized patients in Eurotransplant

In 2008 the Acceptable Mismatch Program (AM) program organized and controlled by the ETRL has been an efficient tool for a number of highly sensitized patients. This program is open for all patients of ET. Information for participation can be obtained directly from the ETRL, the ET Medical Administration, or from the ET website (http://etrl.eurotransplant.nl/cms/index.php). In 2008, 59 patients received a crossmatch negative offer and have been transplanted via this program. In addition, 12 AM patients received a crossmatch negative offer via the regular ETKAS program. The summary of the number of patients transplanted is presented in table 7.2 and figures 7.1 and 7.2. A significant increase both in patients included in the AM as well as transplantation via this program is observed.

Table 7.2 Number of patients transplanted through the AM program

Country New on the AM Waiting list Patients on the AM Waiting list Transplanted % Transplanted / Waiting

Austria 14 18 2 11,1

Belgium 5 18 2 11,1

Croatia 0 4 0 ./.

Germany 55 87 26 25,3

Luxembourg 0 1 0 ./.

Netherlands 36 120 29 24,2

Slovenia 1 1 0 ./.

Total 111 250 59 23,6

65 7.4 Other activities

The ETRL site The site of the ETRL (http://etrl.eurotransplant.nl/cms/index.php)) is open for all laboratories working in the field of organ transplantation immunology and histocompatibility. Besides important information on the duties of the ETRL, the participants of the EPT can download the respective forms for the report of the results as well as the final analysis. Further information of future meetings within ET as well as reports of these meetings is found there. Two new programs already used for several years at the ETRL were put on the public site: the virtual-PRA, which is based on the HLA typing results of organ donors procured in the ET area (N=4000) but which also allows PRA calculations on the national data bases of Austria, Belgium, Germany and the Netherlands. The second program allows the calculation of the chance a highly sensitized patient has to obtain a crossmatch negative organ, when HLA type, blood group and acceptable mismatches are defined.

Annual Tissue Typers Meeting The Annual Tissue Typers Meeting was held in October 2008 in Leiden. Over a 150 participants from the different TTC were present. The topic was the relevance of HLA specific and other antibodies in kidney transplantation. The new techniques leading to a high virtual PRA value were discussed. Patients having antibodies found in solid phase assays only, cannot be accepted in the AM Program, even if their virtual PRA value exceeds 85%. In addition the dispatch of patients sera for crossmatches in the donor center was discussed. Finally a short report on the EPT activities was delivered.

Tissue Typing Advisory Committee (TTAC) The reports of the meetings of the TTAC and the accepted recommendations have been published in the ET Newsletter. The issues discussed were among others, both the acceptance of patients in the Acceptable Mismatch program and the dispatch of sera of sensitized patients for the crossmatch. The TTAC adopted the proposal of the ETRL to not accept patients in the program having solid phase defined antibodies only even if they reach a virtual PRA value of 85%. Whether it is feasible to omit crossmatches for sensitized patients in the donor center (which would mean no shipment of crossmatch sera anymore) will be tested in a restricted area of ET. The new version of the Manual for Histocompatibility Testing was accepted.

Figure 7.1 Number of transplanted AM patients Figure 7.2 Number of patients in the AM program in the respective year

N 60 N 300 50 250

40 200

30 150

20 100

10 50

0 0 A B CRO G NL SLO T A B CRO G L NL SLO OTH TOT

2004 2005 2007 2008 2008 2004 2005 2006 2007 2008

66 8. Scientific Output in 2008

The names of authors who work at the Eurotransplant central office or Eurotransplant Reference Laboratory are in Italic.

PUBLICATIONS - Articles / Abstracts

Waanders MM, Heidt S, Koekkoek KM, Zoet YM, Doxiadis II, Amir A, Heemskerk MH, Mulder A, Brand A, Roelen DL, Claas FH. Monitoring of indirect allorecognition: wishful thinking or solid data? Tissue Antigens. 2008 Jan; 71 (1): 1-15.

Jung GE, Encke J, Schmidt J, Rahmel A Model for end-stage liver disease: New basis of allocation for liver transplantation Chirurg. 2008 Feb; 79 (2): 157-63

Arnold ML, Ensminger SM, Doxiadis II, Spriewald BM. Effect of Donor Cell Type on Complement-Dependent Cytotoxicity Crossmatch Outcome for Patients Immunized Against HLA Class-II Antigens. Exp Clin Transplant. 2008 Mar;6(1):1-6.

Doxiadis GG, Groot de N, Groot de NG, Doxiadis II, Bontrop RE. Reshuffling of ancient peptide binding motifs between HLA-DRB multigene family members: old wine served in new skins. Mol. Immunol. 2008 May; 45 (10): 2743-51.

Barten MJ, Rahmel A, Boldt A, Dhein S, Bittner HB, Tarnok A, Mohr FW, Gummert JF. Pharmacodynamic monitoring of the immunosuppressive therapy in after heart transplantation: whole blood flow cytometric analysis of lymphocyte function Computers in Biology and Medicine, Oct. 2007; vol. 37, issue 10.

Vinkers MT, Rahmel AO, Slot MC, Smits JMA, Schareck WD How to recognize a suitable pancreas donor? A Eurotransplant study of pre procurement factors. Transplantation Proceedings, June 2008 vol. 40; 1275-78.

Arnold ML, Dechant M, Doxiadis II, Spriewald BM Prevalence and specificity of immunoglobulin G and immunoglobulin A non-complement-binding anti-HLA alloantibodies in retransplant candidates Tissue Antigens. 2008 Jul;72(1):60-6.

Waanders MM, Roelen DL, Fijter de JW, Mallat MJ, Ringers J, Doxiadis II, Brand A, Claas F Protocolled blood transfusions in recipients of a simultaneous pancreas-kidney transplant reduce severe acute graft rejection Transplantation. 2008 Jun 15;85(11):1668-70.

Pelleriax B, Roels L, Deynse Van D, Smits JM, Cornu O, Delloy C An analysis of critical care staff’s attitudes to donation in a country with presumed-consent legislation Progress in Transplantation 2008; 18 (3): 1-6.

Slot MC, Sokolowska MG, Savelkouls KG, Janssen RGJH, Damoiseaux JGMC, Cohen Tervaert JW. Immunoregulatory gene polymorphisms are associated with ANCA-related vasculitis. Clin Immunol. 2008 Jul;128(1):39-45. Epub 2008 Apr 29.

Schnuelle P, Goettmann U, Hoeger S, Boesebeck D, Lauchart W, Smith M, Rahmel A, Woude van der F, Yard B Prospective evaluation of donor pre-treatment with dopamine for the prevention of delayed graft function after kidney transplantation: a randomized controlled trial Am. J. Transplant May 2008; Suppl. 2-148; p218.

67 Moers C, Smits JM, Maathuis MHJ, Treckmann J, Gelder Van F, Napieralski BP, Kasterop van-Kutz M, Homan van der Heide JJ, Squifflet JP, Heurn van E, Kirste G, Rahmel A, Leuvenink HGD, Paul A, Pirenne J, Ploeg RJ Transplantation after hypothermic machine perfusion versus static cold storage of deceased donor kidneys: a prospective randomized controlled trial Am. J. Transplant May 2008; Suppl. 2-175; p225.

Smits JM, Rahmel A, Vries de E, Slot M, Boer de J, Tieken I, Frei U, Fijter de JW Dual vs. single kidney transplants in the Eurotransplant senior program Am. J. Transplant May 2008; Suppl. 2-1037; p455.

Gelder Van F, Moers C, Smits JM, Maathuis MHJ, Treckmann J, Napieralski BP, Kasterop van-Kutz M, Homan van der Heide JJ, Heurn van E, Kirste G, Rahmel A, Leuvenink HGD, Paul A, Malaise J, Randon C, Ysebaert D, Squifflet JP, Ploeg RJ, Pirenne J Machine perfusion versus cold storage preservation in non-heart-beating kidney donation and transplantation: first results of a multicentre trial in Eurotransplant Supplement Transplantation, July 27, 2008; vol. 86, nr. 2S-234; p82.

Paul A, Moers C, Smits JM, Maathuis MHJ, Homan van der Heide JJ, Heurn van E, Squifflet JP, Pirenne J, Ploeg RJ, Treckmann J Machine perfusion versus cold storage in transplantation of kidneys from older deceased donors: results of a prospective randomized multicenter trial Supplement Transplantation, July 27, 2008; vol. 86, nr. 2S-236; p83.

Groen H. Moers C, Smits JM, Treckmann J, Gelder Van F, Rahmel A, Paul A, Pirenne J, Ploeg RJ, Buskens E Cost-effectiveness of hypothermic machine perfusion versus static cold storage in kidney transplantation: first results of the prospective European RCT Supplement Transplantation, July 27, 2008; vol. 86, nr. 2S-265; p93.

Roels L, Spaight C, Smits JM, Cohen B Converting the potential for donation after cardiac death into actual donors: a comparison between Belgium and the U.K. Supplement Transplantation, July 27, 2008; vol. 86, nr. 2S-410; p145.

Nickkolgh A, Schemmer P, Gerling T, Weitz J, Büchler MW, Schmidt J Rescue allocation for liver transplantation within Eurotransplant: results of a single center experience Supplement Transplantation, July 27, 2008; vol. 86, nr. 2S-412; p145.

Rahmel A, Smits JM, Vries de E, Slot M, Boer de J, Tieken I Dual vs. single kidney transplants in the Eurotransplant senior program Supplement Transplantation, July 27, 2008; vol. 86, nr. 2S-414; p146.

Schnuelle P, Goettmann U, Hoeger S, Brinkkoetter P, Boesebeck D, Lauchart W, Smith M, Rahmel A, Woude van der F, Yard B Donor dopamine for the prevention of delayed graft function after renal transplantation: a randomized controlled trial Supplement Transplantation, July 27, 2008; vol. 86, nr. 2S-489; p172.

Roels L, Spaight C, Smits JM, Cohen B Donation patterns in 4 European countries: data from the donor action database Supplement Transplantation, July 27, 2008; vol. 86, nr. 2S-754; p264.

Roels L, Spaight C, Smits JM, Cohen B Sustained impact of the donor action methodology on donation practices: a 7-year follow-up in 4 European countries Supplement Transplantation, July 27, 2008; vol. 86, nr. 2S-756; p265.

Groot de N, Doxiadis GGM, Groot de NG, Doxiadis II Reshufffling of ancient peptide binding motifs between HLA-DRB multigene family members: old wine served in new skins Tissue Antigens (2008) vol. 71: 4 p278.

Zoet YM, Pereira E, FrankeMEI, Doxiadis II Potential relevance of HLA-E specific antibodies in renal transplantation Tissue Antigens (2008) vol. 71: 4; p292-293.

68 Doxiadis II, Haasnoot, GW; Rahmel A Identification of parameters that contribute to a successful kidney retransplantation Tissue Antigens (2008) vol. 71: 4; p303.

Vidan-Jeras B, Kovac D, Vončina J, Doxiadis II Joining a large organ exchange organisation: implications for a single center country Tissue Antigens (2008) vol. 71 4; p375.

Vinkers MT, Rahmel AO, Slot MC, Smits JM, Schareck WD Influence of a donor quality score on pancreas transplant survival in the Eurotransplant area Transplant Proc. 2008 Dec; 40(10):3606-3608

Roels L, Spaight C, Smits J, Cohen B Donation patterns in four European countries: data from the donor action database Transplantation 2008 Dec 27;86(12):1738-43

Aurora P, Edwards LB, Christie J, Dobbels F, Kirk R, Kucheryavaya AY, Rahmel AO, Taylor DO, Hertz MI Registry of the International Society for Heart and Lung Transplantation: eleventh official pediatric lung and heart/ lung transplantation report--2008 J Heart Lung Transplant 2008 Sep; 27(9):978-83

Kirk R, Edwards LB, Aurora P, Taylor DO, Christie J, Dobbels F, Kucheryavaya AY, Rahmel AO, Hertz MI Registry of the International Society for Heart and Lung Transplantation: eleventh official pediatric heart transplantation report--2008 J Heart Lung Transplant 2008 Sep; 27(9):970-7

Christie JD, Edwards LB, Aurora P, Dobbels F, Kirk R, Rahmel AO, Taylor DO, Kucheryavaya AY, Hertz MI Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult lung and heart/ lung transplantation report--2008 J Heart Lung Transplant 2008 Sep; 27(9):957-69

Taylor DO, Edwards LB, Aurora P, Christie JD, Dobbels F, Kirk R, Rahmel AO, Kucheryavaya AY, Hertz MI Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult heart transplant report—2008 J Heart Lung Transplant 2008 Sep; 27(9):943-56

Hertz MI, Aurora P, Christie JD, Dobbels F, Edwards LB, Kirk R, Kucheryavaya AY, Rahmel AO, Rowe AW, Taylor DO Registry of the International Society for Heart and Lung Transplantation: a quarter century of thoracic transplantation J Heart Lung Transplant 2008 Sep; 27(9):937-42

Pelleriaux B, Roels L, Van Deynse D, Smits J, Cornu O, Delloye C An analysis of critical care staff’s attitudes to donation in a country with presumed-consent legislation Prog Transplant 2008 Sep; 18(3):173-8

Rahmel A Einfluss der verschiedenen Spenderkriterien auf die Nierenallokation Kongressband zum 4. Jahreskongress der Deutschen Stiftung Organtransplantation, June 12-13,2008, Frankfurt, Germany

Schnuelle P, Göttmann U, Höger S, Bösebeck D, Lauchart W, Smith M, Rahmel A, van der Woude FJ, Yard BA Spender-Vorbehandlung mit Dopamin zur Verbesserung der Initialfunktion nach Nierentransplantation. Eine randomisiert kontrollierte Studie Transplantationsmedizin Supplement II – 2008: Deutsche Transplantationsgesellschaft 17. Jahrestagung

Treckmann J, Moers C, Smits J, Gallinat A, Kirste G, Rahmel A, Leuvenink H, Squifflet JP, Pirenne J, van Heurn E, Ploeg RJ, Paul A, Machine Preservation Trial Ergebnisse der multizentrischen Nierenperfusionsstudie bei Spendern älter als 65 Jahre Transplantationsmedizin Supplement II – 2008: Deutsche Transplantationsgesellschaft 17. Jahrestagung

69 INVITED LECTURES

1. 1. 17. Wintertagung der Arbeitsgruppe Organtransplantation der deutschen Gesellschaft für Kardiologie Münster, Germany, January 11-12, 2008 Das Transplantationsgesetz Rahmel A.

2. 5th Joint Meeting of the German, Austrian and Swiss Societies for Thoracic and Cardiovascular Surgery Innsbruck, Austria, February 17 – 20, 2008 High-urgent transplantation or mechanical support? Conclusions from the Eurotransplant experience Rahmel A

3. 15. Walter Brendel Kolleg; Jubiläumsworkshop – Transplantation: gestern, heute, morgen Wildbad-Kreuth, Germany, February 29-March 1, 2008 Organverteilung durch Eurotransplant Rahmel A.

4. Tagung zur akuten Rechtsproblemen der Transplantationsmedizin Halle-Saale, Germany, March 5-7, 2008 Spezifische Probleme der Organvermittlung bei Eurotransplant Rahmel A.

5. Meeting of the Belgian Transplantation Society Brussels, Germany, March 20, 2008

FREE COMMUNICATIONS:

Sustained impact of the donor action methodology on donation practices: a 7-year fol.low-up in 4 countries. Roels L, Spaight C, Smits JMA

Consent for organ and tissue donation: the thin line between law and practice in a country with a presumed consent. Roels L, Pelleriaux B, Spaight C, Smits JMA

Transplantation after hypothermic machine perfusion versus static cold storage of deceased donor kidneys: a prospective randomized controlled trial. Moers C, Smits JMA, Maathuis MHJ, Treckmann J, Gelder Van F, Napieralski B, Kasterop-Kurz M, Heide van der JJH, Squifflet J-P, Heurn van E, Kirste G, Rahmel A, Leuvenink HGFD, Paul A, Pirenne J, Ploeg RJ.

6. Visit to UK Transplant, Bristol, United Kingdom, March 10 and 11, 2008 Several presentations about current IT system: IT-policy of ET, DPA and donor reports, BPEL/SOA as used in MELD and ENISq, rule engines for matching and simulation. Deijl van der W, Schaafsma M, Zanen W.

7. 19th ESOT Hesperis Course 2007 - 2008 Leiden, the Netherlands, April 22-27, 2008 Allocation policies in Eurotransplant: Kidney, kidney+pancreas + thoracic organs Rahmel A.

8. 49. Österreichischer Chirurgenkongress May 21 – 23, 2008, Innsbruck, Austria Transplantationschirurgie Rahmel, A

9. 2nd Belgian Meeting on Transplantation of Organs from Non-Heart-Beating Donors May 22, 2008, Brussels, Belgium Procedural rules within Eurotransplant Rahmel, A

10. 19. Workshop für experimentelle und klinische Lebertransplantation und Hepatologie May 29-31, 2008, Wilsede, Germany Erste Ergebnisse seit Einführung von MELD Rahmel A

70 11. Forms modernization event Oracle Belgium June 3, 2008, Brussels, Belgium Case study forms integration with web technology Deijl van der W

12. Forms modernization event Oracle the Netherlands June 4, 2008, De Meern, the Netherlands Case study forms integration with web technology Deijl van der W

13. 4. Jahreskongress der Deutschen Stiftung Organtransplantation June 12 – 13, 2008, Frankfurt am Main, Germany Einfluß der verschiedenen Spenderkriterien auf die Nierenallokation Rahmel A

14. 3. Europäischer Medizin-Rechts-Tag September 26, 2008, Salzburg, Austria Eurotransplant – Organspende und –Transplantation in Europa Rahmel A

15. 5th Annual Meeting of the European Transplant Coordination Organization October 3-5, 2008, Riga, Latvia Differences in organ allocation in Europe – Multiorgan allocation Rahmel A

16. Celebration of the 10th European Donation Day October 18, 2008, Ljubljana, Slovenia Equitable access to transplantation Rahmel A

17. 4th National Learning Congress October 23-24, 2008, Nashville, TN, USA Expanding the donor pool: Use of extended criteria donors – the Eurotransplant experience Rahmel A

18. 17. Jahrestagung Deutsche Transplantationsgesellschaft November 20-22, 2008, Bochum, Germany Eurotransplant: die Vermittlungsstelle für die Organtransplantation in Mitteleuropa Rahmel A

19. 9. Kongress der Deutschen Interdisziplinären Vereinigung für Intensivmedizin und Notfallmedizin (DIVI08) December 3-6, 2008, Hamburg, Germany Zuspruchsregelung versus Widerspruchsregelung Rahmel A

ORAL PRESENTATIONS 1. AMIS, sneak preview of Dutch ODTUG presenters May 20, 2008, Nieuwegein, the Netherlands Integrating Oracle forms with other web technologies Deijl van der W

2. ODTUG Kaleidoscope 2008 June 15, 2008, New Orleans, USA The beauty of JSF component based development (during plenary session on opening day of the conference) Deijl van der W

71 3. ODTUG Kaleidoscope 2008 June 17, 2008, New Orleans, USA Integrating oracle forms with other web technologies Deijl van der W

4. ODTUG Kaleidoscope 2008 June 17, 2008, New Orleans, USA The beauty of JSF component based development Deijl van der W

5. 8th International Congress on Lung Transplantation Paris, September 11, 2008 Should the choice between single lung transplant vs. both lung transplant be influenced by the expected survival benefit? Smits J

6. DOPKI meeting Madrid, September 25, 2008 Preliminary report of the safety analysis of ECD transplants Smits J

72 9. Annual Social Report Figures

Intake Number of new Number of employees employees (Dec. 31, 2008) Intake percentage

Regular 7 66 10,6% Student 11 28 39,3%

Total 18 94 19,1%

Outflow Number of employees Exit number (Jan. 1, 2008) Outflow percentage

Regular 7 66 10,6% Student 13 30 43,3%

Total 20 96 20,8%

Employees on December 31, 2008 Numbers FTE FTE*

Students 29 10,06 10,7 Part-timer 31 23,78 21,6 Full-timer 23 23,00 16,1 Full-timer + (>36 hours/week) 11 12,17 9,3

Total 94 69,01 57,7

* The calculation of the number of FTE’s is based on the number of employees actually working for ETI during the year (taking into account the shared services and the exit or entrance of employees during the year).

Male Female

Divison Male/Female Nr. % Nr. %

Regular 27 69,2% 12 30,8% Students 24 43,6% 31 56,4%

Total 51 54,3% 43 45,7%

Average absentee Average absentee Absentee rates Gross absenteeism* Nett absenteeism** frequencies duration

Regular 2,80% 2,80% 1,8 7 days Students 0,04% 0,04% 0,2 2,3 days

* Gross absenteeism concerns all absenteeism caused by illness. ** Nett absenteeism concerns all absenteeism caused by illness, excluding insured absenteeism. In case of insured absenteeism, the employer receives sickness benefits for the absenteeism.This involves absenteeism related to pregnancy or maternity, organ donation or with regard to employees who have a prior history of insured absenteeism.

73 10. Abbreviated financial statements

Abbreviated financial statements of Stichting Eurotransplant International Foundation for the year ended December 31, 2008

For a full understanding of the Foundation’s financial position and results, the abbreviated financial statements should be read in conjunction with the financial statements from which the abbreviated financial statements have been derived.

Balance sheet

Assets 31.12.2008 31.12.2007 x € 1.000 x € 1.000

Fixed assets 728 905 Short term receivables 1.948 2.104 Liquid assets 1.011 783

3.687 3.792

Liabilities 31.12.2008 31.12.2007 x € 1.000 x € 1.000

Capital 235 235 Reserve funds 1.949 1.854 Provisions 46 - Short term liabilities 1.457 1.703

3.687 3.792

Statement of income and charges

Income 2008 2007 x € 1.000 x € 1.000

Registration fees 5.634 5.075 Procurement fees 2.290 2.086 Miscellaneous 8 44 Extra-ordinary income 61 191

7.993 7.396

Charges 2008 2007 x € 1.000 x € 1.000

Salaries 3.911 4.048 Procurement charges 2.278 2.261 General expenses 617 935 Medical expenses 67 66 Transport 13 43 Housing 236 251 Depreciation 296 274 Miscellaneous 479 400 Extra-ordinary expenses - -

7.897 8.278

Exploitation balance 96 -882

74

Appropriation of the exploitation balance

Addition Reserve Fund explantation costs 12 -154 Release Reserve Fund Reorganization -25 -289 Release Reserve Fund Organizational Backlog - -250 Addition Tariff Equality Reserve 74 -154 Addition Other reserves 35 -35

96 -882

Accounting policies

General accounting principles for the preparation of the financial statements The financial statements have been prepared in accordance with Guideline 640 of the DutchAccounting Guidelines.

Valuation of assets and liabilities and determination of the result takes place under the historical cost convention. Unless presented otherwise at the relevant principle for the specific balance sheet item, assets and liabilities are presented at face value.

Income and expenses are accounted for on accrual basis. Profit is only included when realized on the balance sheet date. Losses originating before the end of the financial year are taken into account if they have become known before preparation of the annual accounts.

Financial instruments Financial instruments be both primary financial instruments, such as receivables and payables, and financial derivatives. For the principles of primary financial instruments, reference is made to the treatment per balance sheet item.

Translation of foreign currency Receivables, liabilities and obligations denominated in foreign currency are translated at the exchange rates prevailing at balance sheet date.

Transactions in foreign currency during the financial year are recognized in the financial statements at the exchange rates prevailing at transaction date. The exchange differences resulting from the translation as of balance sheet date, taking into account possible hedge transactions, are recorded in the profit and loss account.

Principles of valuation of assets and liabilities

Tangible fixed assets Fixed assets are stated at costs less accumulated depreciation. Depreciation is based on the estimated useful life and calculated as a percentage of cost, taking into account any residual value.

Accounts receivable Receivables are included at face value, less any provision for doubtful accounts.

Other receivables, prepaid expenses, accruals and short term liablities These items are stated at nominal value.

Reserve Funds Reserve Funds are formed for future expenditures which should be covered out of the current available assets.

Provisions The provision for jubilees is based on the expected costs for a series of years. Payments for a jubilee are deducted from the provision. The provision is recognized as of 2008.

Provision for employee benefits Industry pension fund scheme:

75 The organization is associated with an industry pension fund according to the Collective Labour Agreement for General Hospitals. The pension plan taken care of by the fund is a defined benefit plan. A defined beneifit plan has been recognized as if it were a defined contribution plan, as the organization has no commitment to make additional contributions in the event of a deficit other than higher future premiums.

Principles for the determination of the results

Registration fees Registration fees are taken into account as of the date of entry on the waiting list of Eurotransplant.

Charges The general expenses of the Stichting Eurotransplant International Foundation are stated on the basis of transaction costs.

Certain general expenses of the Nederlandse Transplantatie Stichting, Stichting Bio Implant Services Foundation and Stichting Eurotransplant International Foundation are made for common account. Such costs are divided between the three foundations on the basis of activity levels.

Exploitation Balance The exploitation balance is defined as the difference between income and related charges, based on the above mentioned policies.

Auditor’s Report

Introduction We have audited whether the accompanying abbreviated financial statements of Stichting Eurotransplant International Foundation, Leiden, for the year 2008 have been derived consistently from the audited annual accounts of Stichting Eurotransplant International Foundation, for the year 2008. In our auditors’ report dated March 17, 2009 we expressed an unqualified opinion on these annual accounts. The board of directors is responsible for the preparation of the abbreviated financial statements in accordance with the accounting policies as applied in the 2008 annual accounts of Stichting Eurotransplant International Foundation. Our responsibility is to express an opinion on these abbreviated financial statements.

Scope We conducted our audit in accordance with Dutch law. This law requires that we plan and perform the audit to obtain reasonable assurance that the abbreviated financial statements have been derived consistently from the annual accounts. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion.

Opinion In our opinion, these abbreviated financial statements have been derived consistently, in all material respects, from the financial statements.

Emphasis of matter For a better understanding of the foundation’s financial position and results and the scope of our audit, we emphasize that the abbreviated financial statements should be read in conjunction with the unabridged annual accounts, from which the abbreviated financial statements were derived and our unqualified auditors’ report thereon dated March 17, 2009. Our opinion is not qualified in respect of this matter.

Leiden, March 17, 2009

Deloitte Accountants B.V.

drs. G.J.W. Coppus RA

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