Expanding the donor pool to increase renal transplantation.

INTRODUCTION The goal of the Eurotransplant renal allocation scheme is to provide every patient on the waiting list with a reasonably balanced opportunity for a donor offer. New initiatives were taken in order to maximize donor usage while maintaining a successful transplant outcome. METHODS Two Eurotransplant projects were launched in order to accommodate changes in donor and recipient profiles. A re-addressing of the non-heart-beating donor pool was undertaken and an allocation scheme in which organs from donors aged >65 are allocated to recipients aged >65 [the Eurotransplant Senior Programme (ESP)] was introduced. RESULTS Especially in The Netherlands, an enormous increase in the number of non-heart-beating donor kidneys has been observed, however with a pace-keeping reduction in heart-beating donors. The organization-wide implementation of the ESP has been successful. The 3 year graft survival rates for these age-matched transplants were as good as the human leukocyte antigen (HLA)-matched transplants (64 vs 67%) (P = 0.4). CONCLUSION Within the framework of sound research, the utmost flexibility and creativity is needed to keep or even increase the number of renal transplants when faced with a quantitatively stagnating but qualitatively deteriorating donor pool. Both the non-heart-beating donor protocol and the ESP have proven to be quite successful in achieving this goal without compromising the outcome for the individual end-stage renal disease patient.

[1]  Yves Vanrenterghem,et al.  The new Eurotransplant kidney allocation system: a justified balance between equity and utility? , 1999 .

[2]  W. Land,et al.  The ethics of organ allocation: the state of debate. , 1997, Transplantation reviews.

[3]  J. Grinyó,et al.  Optimizing Cadaveric Organ Procurement: the Catalan and Spanish Experience , 2003, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[4]  H C van Houwelingen,et al.  Analysis of the renal transplant waiting list: application of a parametric competing risk method. , 1998, Transplantation.

[5]  G Opelz,et al.  The new Eurotransplant Kidney Allocation System: report one year after implementation. Eurotransplant International Foundation. , 1998, Transplantation.

[6]  G. Persijn,et al.  Changing patterns in organ donation in Eurotransplant, 1990–1994 , 1997, Transplant international : official journal of the European Society for Organ Transplantation.

[7]  D. Gjertson,et al.  Senior citizens pool for aged kidneys. , 1997, Transplantation proceedings.

[8]  H. V. van Houwelingen,et al.  Permanent detrimental effect of nonimmunological factors on long-term renal graft survival: a parsimonious model of time-dependency. , 1999, Transplantation.

[9]  G. Persijn,et al.  ANALYSIS OF THE RENAL TRANSPLANT WAITING LIST , 1998 .

[10]  D. Gjertson,et al.  Transplantation of kidneys from donors whose hearts have stopped beating. , 1998 .

[11]  E. Heineman,et al.  Retrospective analysis of the outcome of transplantation of non-heart-beating donor kidneys. , 1995, Transplantation proceedings.

[12]  S. Loening,et al.  "Old-for-old" cadaveric renal transplantation: surgical findings, perioperative complications and outcome. , 2003, European urology.

[13]  M. Durão,et al.  Kidney transplantation from donors without a heartbeat. , 2002, The New England journal of medicine.

[14]  H. Mahanty,et al.  Expanding the Donor Pool: Can the Spanish Model Work in the United States? , 2003, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[15]  G. Krejs,et al.  Elderly patients and chronic haemodialysis , 1992, The Lancet.

[16]  P. Hauptman,et al.  Procurement and allocation of solid organs for transplantation. , 1997, The New England journal of medicine.

[17]  Nigel Gough,et al.  Fractals, chaos, and fetal heart rate , 1992, The Lancet.

[18]  A. Markezich,et al.  A review of the kidneys that nobody wanted: determinants of optimal outcome. , 1998, Transplantation.

[19]  A. Kaider,et al.  Parameters associated with chronic renal transplant failure. , 1997, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[20]  Ulrich Frei,et al.  Evaluation of the Eurotransplant Senior Program. The Results of the First Year , 2002, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[21]  M. Denton,et al.  Outcome of transplantation of non-heart-beating donor kidneys , 1995, The Lancet.

[22]  Lutz Fritsche,et al.  Old‐for‐Old Kidney Allocation Allows Successful Expansion of the Donor and Recipient Pool , 2003, American Journal of Transplantation.