Eurotransplant

Eurotransplant (ET) was established in 1967 as an international foundation based in Leiden (the Netherlands) (Krukemeyer 2008).

ET is a central organ procurement agency for post-mortem donated organs, which currently includes eight European countries:

• Belgium
• Germany
• Luxembourg
• The Netherlands
• Croatia
• Austria
• Slovenia
• Hungary (Kuhlmann 2015)

Eurotransplant primarily pursues two goals:

• to optimize compatibility by increasing the size of the donor and recipient group
• To achieve the fairest possible distribution of organs through agreed distribution rules (Krukemeyer 2008).

The Transplantation Act (TPG) came into force in Germany in 1997. It regulates the donation, removal, procurement and transfer of organs. The guideline competence for organ transplantation lies with the German Medical Association (Bundesärztekammer) (Herold 2020). Since then, Eurotransplant has been the official intermediary for transplants in Germany (Krukemeyer 2008). There are currently more than 250 transplant programs at ET (Krukemeyer 2008).

Organ donation

Potential organ donors are promptly reported to ET and entered into the allocation process. Organs are then allocated according to their urgency, likelihood of success and equality of opportunity (Krukemeyer 2008). In the Netherlands and Belgium, so-called non-heart-beating donors are also possible, i.e. removal and placement of organs after cardiac arrest.

A distinction is made between several categories:

• Category I:

This is a so-called "uncontrolled" donation, where the patient has already suffered a cardiac arrest on arrival at the hospital.

• Category II:

This is also an "uncontrolled" donation, but where resuscitation was unsuccessful and it has already been terminated.

• Category III:

Category III is a so-called "controlled" donation in which cardiac arrest is already expected. Ventilation and drug therapy are deliberately discontinued and cardiac arrest is awaited. As soon as cardiac arrest has occurred, the organs are removed 10 minutes later.

• Category IV:

This is also a so-called "controlled" donation, except that cardiac arrest has occurred only after brain death has already been established. As soon as cardiac arrest has occurred, the organs are removed 10 minutes later (Krukemeyer 2008).

Organ recipient: Prerequisite for notification and listing in ET is a comprehensive physical and apparative examination of the patient, and in particular the determination of the following laboratory values (Herold 2020 / Geberth 2015):

• Blood grouping
• HLA typing
• Anti- HLA alloantibody screening
• Autoantibody

ETKAS

The allocation of the donor organ is done according to a point system. The Euro Transplant Kidney Allocation System (ETKAS) was introduced in 1996. Points are allocated depending on:

• Blood group compatibility
• Mismatch probability (see also cross-match test)
• HLA match
• Waiting time
• Ischemia time

Additional points are awarded for

• High urgency
• Children, adolescents, adolescents (Bundesärztekammer 2013)

ETKAS leads to more transplantations in:

• so-called long-waiters (plus 21 %)
• Children
• without mismatch (plus 23 %)
• highly presensitized patients
• fewer transplants of mismatch (< 3 %) (Keller 2010)

Eurotransplant Senior Program

In 1999, the Eurotransplant Senior Program (ESP / old for old) was launched by EP. This covers donor kidneys that are 65 years or older.

The aim of ESP is to place these donor kidneys with older recipients in order to:

• take into account the specificities of older donor kidneys and the transplantation of older recipients
• shorten the waiting time for them

Recipients must not have been transplanted before and must have < 5 % panel reactive antibodies (PRA). Blood group compatibility is a prerequisite for transplantation, but HLA matching is not optimized, since the immune system reacts increasingly weakly to foreign antigens in old age and older kidneys are particularly sensitive with regard to ischemia time (Kasper 2015; Keller 2010).

Long-term outcomes of the senior program were assessed in a study of 423 transplant candidates, of whom 258 were transplanted, between 1999 and 2012.

Mortality rate per 100 patient-years:

• 6.8 in waiting list patients
• 5.4 in transplant recipients
• 3.6 in transplant recipients without graft loss
• 8.6 in recipients of transplants with graft loss (Glander 2018)

Results: Eurotransplant has matched organs from more than 45,000 donors to over 112,000 recipients since its establishment in 1967. The frequency of transplantation included:

• Kidneys with > 70,000 the most frequent
• Liver > 17.000
• heart > 12.000
• lungs > 3.000
• combined heart-lung transplantation > 3.000
• Pancreas and combined pancreas-kidney transplants > 700 (Krukemeyer 2008)

1. German Medical Association (2013) Guidelines for waiting list management and organ procurement for kidney transplantation according to § 16 para. 1 p. 1 nos. 2 and 5 TPG
2. Geberth S et al (2011) Practice of dialysis according to the guidelines NKF KDOQITM, KDIGO, EDTA, DGfN. Springer Verlag 260
3. Glander P et al (2018) Kidney transplantation in old age - a challenge. Kidney and hypertension diseases Years 47 (1) 20 - 26
4. Herold G et al (2020) Internal medicine. Herold Publisher 647
5. Kasper D L et al (2015) Harrison's Internal Medicine. Georg Thieme Publisher 2248
6. Keller C K et al (2010) Practice of nephrology. Springer publishing house 301, 330 - 331
7. Krukemeyer M G et al (2008) Transplantation Medicine: A Guide for the Practitioner. de Gruyter Publishers 65 - 68
8. Kuhlmann U et al (2015) Nephrology: Pathophysiology - Clinic - Kidney replacement procedure. Thieme Publishing House 766