1. Strategies to increase transplantation
Professor John Forsythe

2. Outline Living donation and transplantation
Length of donation–transplantation process
Organ utilisation

3. Up to 40 liver donors per year
Living donors in the UK
Up to 40 liver donors per year

4. International data - living donor (LD) kidney transplant rates
2010

5. Increasing complexity of living donor kidney transplantation
Adult living donor transplants
Increasing complexity of living donor kidney transplantation

6. Adult living donor transplants
Steady fall in both ABOi and HLAi adult living donor kidney transplants since 2012/13

7. Adult living donor transplants
Rise in both paired and altruistic adult living donor kidney transplants

8. UK Living Kidney Sharing Schemes (UKLKSS)
Include:
Paired/pooled donation (PPD)
Altruistic Donor Chains (ADC)
Non-directed altruistic donation (NDAD)
ODT, NHSBT November 2011 8

9. Non-Directed Altruistic Donation
Direct to Waiting List Short AD Chain (ADC) Long ADC AD AD
KEP
pairs AD D1 R1 D1 R1 WL D2 R2 WL WL
ODT, NHSBT November 2011 9

10. Transplants according to exchange type
Altruistic donor and kidney exchange transplants
No. of transplants
Transplants according to exchange type
ODT, NHSBT November 2011 10

11. Types of incompatibility between registered pairs to 31 Dec 2016
Since 20th October 2011

12. HLA MM and Age difference of registered compatible pairs
HLA Level
HLA MM N 2
110 1 3
n=7
111 4
211
220
n=58
021
022
112
121
122 14
212 6
221 10
222 17
Age diff N
±20 yrs 54
±30 yrs 7
±40 yrs 4
±60 yrs 1
Median age of recipients: 44 (33 – 51)
Min = 2, Max = 66

13. Minimum match grade and
maximum donor age specified for recipients in compatible pairs
Match grade N
***=3 1
**0=2 5
**1=2
**1=3 19
011
110 3
111 21
211 7
220 2
112
221
222
HLA Level 4

14. Outcomes for 66 registered compatible pairs
74% of compatible pairs only enter 1 matching run

15. Transplants enabled by compatible pairs
29 compatible pairs enabled:
3 short altruistic donor chains
2 long altruistic donor chains
7* two-way exchanges
17 three-way exchanges
75 transplants
10 HSP
*One two-way exchange was between two compatible pairs

16. Predicted 15 year graft survival
by HLA level based on a recipient with “baseline” values
78%
HLA Level 1: 78%
HLA Level 2: 75%
HLA Level 3: 71%
HLA Level 4: 69%
“Baseline” values
14.8yrs
13.3yrs
Donor age = 46
Recipient age = 36
Transplant year = 2007
PRD = Glomerulonephritis
11.3yrs
10.1yrs

17. Types of incompatibility between
registered pairs to 31 Dec 2016 by centre
11 centres registered compatible pairs

18. Length of donation-transplantation process

19. DBD donation process
10.5 hours longer

20. DCD donation process
8.5 hours longer

21. Offering and retrieval planning
DBD
DCD

22. Why does it matter?

23. Time of family approach
DBD
DCD

24. DBD retrieval operation start times
Shift in time of day from 2-5 am to 6-12 am

25. DBD process Cardiothoracic organs retrieved
Cardiothoracic organs not retrieved

26. Shift in time of day from 10pm-3 am to 4-12 am
DCD withdrawal of treatment times
Shift in time of day from 10pm-3 am to 4-12 am

27. Reasons for family not giving consent/authorisation for donation4%
17 families
15%
124 families
2015/16 data: 405 DBD families, 829 DCD families

28. Organ utilisation

29. Kidney offers, retrievals and transplants

30. Offers, retrievals and transplants
liver
kidney
pancreas
heart
lung

31. Discard rates for kidneys from deceased donors, 2014
% of retrieved kidneys not transplanted N=
No. kidneys retrieved
¹ 2012 data
% adult deceased donor
kidney transplants from DCD
~ 11% in Spain
~ 15% in US
~ 37% in UK
~ 26% in Australia
Source: ONT – Spain data, OPTN - US data
ANZ - Australia data, NHSBT - UK data
24% overall
10% overall
19% overall

33. Summary Living donation UK Living Kidney Sharing Schemes a big success
Organ offering taking longer
Impacting on time of day of retrieval and transplantation surgery
NHSBT initiative to streamline the process
Need to address organ utilisation
UK Strategy for Organ Utilisation

34. Acknowledgements
Transplant unit, H&I laboratory and other hospital staff and Specialist Nurses for Organ Donation for provision of data to the UK Transplant Registry
RTSM, February 2017