1. Eurotransplant: An example of success for cross-border cooperation Bruno Meiser Eurotransplant International Foundation, Leiden, Netherlands Dept. of Cardiac Surgery University of Munich/Grosshadern Medical Center

2. Scandiatransplant UK Transplant AdB, France Swiss Transplant Lusotransplante ONT, Spain EurotransplantBalttransplantPoltransplantCzechtransplantHungarotransplant CNT, Italy HNTO, Greece 12 European Organ Exchange Organisations

3. 5966 OEOs, by number of deceased donor transplants in 2003

4. History Mission and goals Organisational structure Donation and waiting lists ET allocation system - advantages of the international cooperation - -Improved matching with better outcome - -High urgency (HU) allocation - -Help for special patient groups - -Prevention of loss of donor organs Eurotransplant: An example of success for cross-border cooperation

5. 1967 A proposal for international cooperation in organ transplantation (based on HLA matching): EUROTRANSPLANT INTERNATIONAL FOUNDATION Prof. Dr. J.J. van Rood

6. 2007 ET/Ministers conference: Affirmation of the ET mission

7. History Mission and goals Organisational structure Donation and waiting lists ET allocation system - advantages of the international cooperation - -Improved matching with better outcome - -High urgency (HU) allocation - -Help for special patient groups - -Prevention of loss of donor organs Eurotransplant: An example of success for cross-border cooperation

8. Eurotransplant mission/goals International non-profit organization, coordinating national allocation and international exchange of scarce organs

9. Eurotransplant mission/goals International non-profit organization, coordinating national allocation and international exchange of scarce organs Aim is to encourage organ transplantation, to increase organ availability and use and to improve transplantation outcome by:

10. Eurotransplant mission/goals International non-profit organization, coordinating national allocation and international exchange of scarce organs Aim is to encourage organ transplantation, to increase organ availability and use and to improve transplantation outcome by: - - Providing a transparent and objective selection system based on medical criteria Recipient Information Donor Information Computer Best Match

11. Eurotransplant mission/goals International non-profit organization, coordinating national allocation and international exchange of scarce organs Aim is to encourage organ transplantation, to increase organ availability and use and to improve transplantation outcome by: - - Providing a transparent and objective selection system based on medical criteria - - Assessing factors influencing transplant outcome and subsequently improving transplantation results based on scientific research

12. Eurotransplant mission/goals International non-profit organization, coordinating national allocation and international exchange of scarce organs Aim is to encourage organ transplantation, to increase organ availability and use and to improve transplantation outcome by: - - Providing a transparent and objective selection system based on medical criteria - - Assessing factors influencing transplant outcome and subsequently improving transplantation results based on scientific research - - Promoting and supporting transplantation in an extended European Community

13. Visit of the European Commissionar for Health & Consumer Protection, Androulla Vassiliou in September 2008

14. International Eurotransplant Foundation: 125 millionen inhabitants in 7 states Zagreb 26.05.2006

15. History Mission and goals Organisational structure Donation and waiting lists ET allocation system - advantages of the international cooperation - -Improved matching with better outcome - -High urgency (HU) allocation - -Help for special patient groups - -Prevention of loss of donor organs Eurotransplant: An example of success for cross-border cooperation

16. Leiden 69 38 4 41 25 39 ET Transplantion-Programs (n=216)

17. Board Ethics Com. Organ Procurement Com. ETKAC ELIAC ETHAC EPAC ET Board + Advisory Committees Financial Com. Tissue Typing Adv. Com. Comp. Serv. Work. Group

18. History Mission and goals Organisational structure Donation and waiting lists ET allocation system - advantages of the international cooperation - -Improved matching with better outcome - -High urgency (HU) allocation - -Help for special patient groups - -Prevention of loss of donor organs Eurotransplant: An example of success for cross-border cooperation

19. The question of allocation equity is caused by the discrepancy between

20. …and growing active waiting lists in ET (per organ as of December 31st / each year)

21. Post-mortem donation per million population ET 1992 - 2005

22. 34.3 13.2 25.3 21 23.9 10.7 21 19.2 18.7 13.2 19.9 14.5 17.2 27.2 15.7 15 11.4 15.6 21.1 21.6 2.1 1.2 13.1 14.1 8.5 0 26.9 5.8 Organ donation rates in Europe Organ donors p.m.p. 2007

23. 27.2 15,7 11.4 15.2 21.6 13.1 Organ donation rates in ET Organ donors p.m.p. 2007

24. Organ donors p.m.p. 2008 vs. 2007 27.2 15,7 11.4 15.2 21.6 13.117.9 17.8 20.2 14.4 12.3 24.9 Organ donation rates in ET

25. Total in the EU 4,317 persons (12 persons/day) Deaths on waiting lists – European Union 2007

26. History Mission and goals Organisational structure Donation and waiting lists ET allocation system - advantages of the international cooperation - -Improved matching with better outcome - -High urgency (HU) allocation - -Help for special patient groups - -Prevention of loss of donor organs Eurotransplant: An example of success for cross-border cooperation

27. Organexchnge in the ET-area Kidney transplantation 2000-2004 The Netherlands GermanySlovenia 8668 1358 1386 103 1919 AustriaBelgium 95 63 245 303 16 10 12 283 256 102 101 45 49 44 57 36 12 460 493

28. History Mission and goals Organisational structure Donation and waiting lists ET allocation system - advantages of the international cooperation - -Improved matching with better outcome - -High urgency (HU) allocation - -Help for special patient groups - -Prevention of loss of donor organs Eurotransplant: An example of success for cross-border cooperation

29. Kidney graft survival and HLA-ABDR mismatches Adult first cadaver kidney-only transplants Post-transplant time (m) P=0.0001 % 83% 71%

30. 100%10073total 0,4%446 2,4 % 2445 10,5 % 10554 30,2%30433 26,6 % 26792 8321 2176 0 Percentage No. of transplantations No. of mismatches HLA-matching in kidney transplantation ET 2000-2004, non-ESP patients 21,6 % 8,3 %

31. History Mission and goals Organisational structure Donation and waiting lists ET allocation system - advantages of the international cooperation - -Improved matching with better outcome - -High urgency (HU) allocation - -Help for special patient groups - -Prevention of loss of donor organs Eurotransplant: An example of success for cross-border cooperation

32. n=201 (16%)n=1053 (84%) HU transplantion liver Waiting time [n=1254] Children (<16 a) Adults (16+ a) Median waiting time: 2 d (both groups)

33. History Mission and goals Organisational structure Donation and waiting lists ET allocation system - advantages of the international cooperation - -Improved matching with better outcome - -High urgency (HU) allocation - -Help for special patient groups - -Prevention of loss of donor organs Eurotransplant: An example of success for cross-border cooperation

34. Mean waiting time kidney-transplantation Impact of the AM-program on highly-immunized patients, Eurotransplant 2006 n=26 n=3137n=47

35. International organ exchange in kidney transplantation Impact for selected patient groups Eurotransplant 01.01.2002 -31.12.2006

36. History Mission and goals Organisational structure Donation and waiting lists ET allocation system - advantages of the international cooperation - -Improved matching with better outcome - -High urgency (HU) allocation - -Help for special patient groups - -Prevention of loss of donor organs Eurotransplant: An example of success for cross-border cooperation

37. Development of donation numbers for different donor age groups Reported kidney donors, Eurotransplant, 2000-2006 Donor age groups Number of donors (in relation to 2000)

38. Cecka, et al. Transplantation 2006; 81: 966-70 Turn-down of kidneys accord. to donor age: Eurotransplant vs. U.S.A.

39. National organ import and export for different blood groups and countries Slovenia Netherlands Germany Belgium 100% 38,5% 18,4% 73,5%36,7%53,4% 18,8% 10,7% 29,5%22,1%100% 28,9% 14,4% 73,9%41,2%55,1% 18,3% 10,7% 34,5%19,7%Austria ABAABA ImportExport

40. Slovenia Netherlands Germany Belgium 100% 38,5% 18,4% 73,5%36,7%53,4% 18,8% 10,7% 29,5%22,1%100% 28,9% 14,4% 73,9%41,2%55,1% 18,3% 10,7% 34,5%19,7%Austria ABAABA ImportExport

41. Summary The donation rates in many European / some ET countries are still unsatisfactory; there is an increasing gap between donation rate and demand for transplantationThe donation rates in many European / some ET countries are still unsatisfactory; there is an increasing gap between donation rate and demand for transplantation ET has successfully served more than 130.000 pts. by allocating 82.000 kidney-, 24.000 liver-, 15.000 heart-, 5.000 pancreas-, and 4.500 lung grafts through a transparent, quality and safety oriented allocation systemET has successfully served more than 130.000 pts. by allocating 82.000 kidney-, 24.000 liver-, 15.000 heart-, 5.000 pancreas-, and 4.500 lung grafts through a transparent, quality and safety oriented allocation system The collaboration within Eurotransplant offers additional benefits to participating centers and countries, e.g. trough improved patient oriented allocation, help for high urgency patient and for special patient group as well as avoidance of donor organ lossThe collaboration within Eurotransplant offers additional benefits to participating centers and countries, e.g. trough improved patient oriented allocation, help for high urgency patient and for special patient group as well as avoidance of donor organ loss

42. Promotion and support of Tx in an extended European Community Stepwise approach to incorporate new members within the framework of a preliminary cooperation agreement in order to provide immediate support with regard to urgent pts., highly sensitized pts., childrenStepwise approach to incorporate new members within the framework of a preliminary cooperation agreement in order to provide immediate support with regard to urgent pts., highly sensitized pts., children Ultimate goal is a full membership within an acceptable timeframeUltimate goal is a full membership within an acceptable timeframe  Increase of the donor pool for all patients to improve outcome  Increase of the donor pool for all patients to improve outcome Eurotransplant Goals Outlook