One waiting list
All transplantation centers within the member states of Eurotransplant have access to the central computer database. In this database, the transplantation centers enter the general and medical information of their recipients along with the recipient profile and the donor profile. These profiles contain the characteristics of patients and donors. This is the basic principle of making the best match possible given the circumstances. When the information is entered into the central database, the patient is put on the (inter)national waiting list. At that point, the waiting time starts. The waiting time for kidney patients starts on the date of the first dialysis.
Making the match
As soon as a donor becomes available within the Eurotransplant area, the regional tissue-typing laboratory determines the donor’s blood group and tissue characteristics. All relevant (medical) information about the donor as well as information about the specific organs are transferred into the Eurotransplant database. Eurotransplant generates a so-called match list for each donor organ. The match list is generated by a complicated computer algorithm that takes into account all medical and ethical criteria.
The allocation system is
- Objective: the match list is the same no matter which duty desk officer arranges the allocation
- Reproducible: the same question will lead to the same answer
- Transparent: every step in the process can be accounted for
- Valid: the system is based upon valid medical and ethical criteria that are supported by consensus within the transplant community.
The match is based upon two general principles
- Expected outcome
- Urgency (as determined by experts in an objective and transparent way)
Furthermore, the following is taken into account
- National organ balance – for Eurotransplant pursuits a reasonable balance in the exchange of organs between countries
- Waiting time
Offering donor organ(s)
The donor organs are offered to recipients according to their ranking on the match list. The duty desk officers of Eurotransplant inform the transplant coordinators and physicians in the patient’s transplant center. They also inform the transplant center of the second patient on the match list. The donor information is made available to both transplant centers. The treating physicians decide whether or not to accept the organ.
As soon as the organ is accepted, the physician contacts the patient. Eurotransplant establishes contact between the donor hospital and the transplant center. The exact time of the procurement operation is determined. This happens in consultation with the transplant coordinator of the donor hospital. At the same time, the (crossborder) transportation of the organs from the donor hospital to the recipient(s) in the transplant hospitals is arranged.
If there are no suitable recipients within the Eurotransplant area, Eurotransplant contacts a sister organization.
The Model for End-stage Liver Disease (MELD) scoring system aims at stratifying recipients by their disease severity according to a score estimating the 3-month probability of death on the waiting list.
A high MELD indicates severe illness, thus a candidate in urgent need of transplantation and vice versa. Candidates are stratified in a descending order starting with the highest MELD. The calculation of an individual’s MELD score is based on three objective lab parameters, i.e.
- International Normalized Ratio (INR)
MELD was developed by the Organ Procurement and Transplantation network (OPTN)/United Network for Organ Sharing (UNOS) and implemented in February 2002. The Eurotransplant Board decided in 2003 to implement MELD for liver allocation in Eurotransplant.