3. 2009
“The PerfecT MaTch”
LegaLLy founded: May 12, 1969
ISo certified 9001:2008
Edited by
Arie Oosterlee and Axel Rahmel
CIP-GEGEVENS KONINKLIJKE BIBLIOTHEEK, DEN HAAG
Annual Report/Eurotransplant International Foundation.–Leiden:
Eurotransplant Foundation. -III., graf., tab.
Published annually
Annual report 2009 / ed. by Arie Oosterlee and Axel Rahmel
ISBN-13: 978-90-71658-29-7
Keyword: Eurotransplant Foundation; annual reports.
2 electronic,
4. Table of contents
- Board of EuroTransplanT InTErnaTIonal foundaTIon 7
- TRANSPLANT PROGRAMS AND THEIR DELEGATES IN 2009 8
- Renal programs 8
- Heart programs 9
- Lung programs 10
- Liver programs 11
- Pancreas (islet) programs 12
- Tissue typing laboratories 12
- forEword 15
1. rEporT of ThE Board and ThE cEnTral offIcE of 16
sTIchTIng EuroTransplanT InTErnaTIonal foundaTIon
1.1 Report of the Eurotransplant Board 16
1.2 Report of the Eurotransplant office 18
1.3 Future policy 20
1.4 Quality Assurance & Safety 20
1.5 Advisory Committees 21
1.6 Recommendations approved 24
2. BasIc prIncIplEs of ThE EuroTransplanT communITy 27
2.1 Eurotransplant mission statement 27
2.2 Basic Mandate of Eurotransplant 27
2.3 Joint Declaration on cooperation within the framework of Eurotransplant International Foundation 30
3. EuroTransplanT: donaTIon, waITIng lIsTs and TransplanTs 32
- Introduction 32
Table 3.1 Number of deceased organ donors used for a transplant, by donor country, from 2005 to 2009 33
Figure 3.1 Median age of deceased donors in Eurotransplant, used for a transplant 33
Table 3.2(i) Number of deceased organ donors used for a transplant, by organ, from 2005 to 2009 33
Table 3.2(ii) Number of deceased organ donors used for a transplant, by organ and donor country, in 2009 33
Table 3.3(i) Demographic data on deceased organ donors, used for a transplant, from 2005 to 2009 34
Table 3.3(ii) Demographic data on deceased organ donors, used for a transplant, in 2009 34
Table 3.4a(i) Number of donors, used for a transplant, by type of donor, from 2005 to 2009 35
Table 3.4a(ii) Number of donors, used for a transplant, by type and donor country, in 2009 35
Table 3.4b(i) Number of deceased donors, used for a transplant, by type of donor, from 2005 to 2009 35
Table 3.4b(ii) Number of deceased donors, used for a transplant, by type and donor country, in 2009 35
Table 3.4c(i) Non-heart beating (NHB) donors, used for a transplant, from 2005 to 2009 35
Table 3.4c(ii) Non-heart beating donors, used for a transplant, by donor country, in 2009 36
Table 3.4d(i) Transplants from NHB donors, from 2005 to 2009 36
Table 3.4d(ii) Transplants from NHB donors, by donor country, in 2009 36
Table 3.5(i) Active Eurotransplant waiting list, by organ, as per December 31, from 2005 to 2009 36
Table 3.5(ii) Active Eurotransplant waiting list, by organ, as per December 31, 2009 37
Table 3.6(i) Registration events on the Eurotransplant waiting list, by organ, from 2005 to 2009 38
Table 3.6(ii) Registration events on the Eurotransplant waiting list, by organ and country, in 2009 38
Table 3.7(i) Number of transplanted organs**, by organ, by donor type, from* 2005 to 2009 39
3
5. Table 3.7(ii) Number of transplanted organs**, by organ, by donor type, by country of transplant, in* 2009 39
Table 3.8(i) Transplants from 2005 to 2009 39
Table 3.8(ii) Transplants in 2009, by transplant country 40
Table 3.9(i) Mortality on the Eurotransplant waiting list, by date of death, from 2005 to 2009 40
Table 3.9(ii) Mortality on the Eurotransplant waiting list in 2009, by country 41
Figure 3.2 Median age of patients on active waiting list 41
Figure 3.3 Median age of transplant recipients (deceased donor transplants) 41
Figure 3.4 Median waiting time for patients on active waiting list at year end 42
Figure 3.5 Median waiting time to transplant (deceased donor transplants) 42
4. KIdnEy: donaTIon, waITIng lIsTs and TransplanTs 43
Table 4.1(i) Deceased donors / kidneys in Eurotransplant, from 2005 to 2009 43
Table 4.1(ii) Deceased donors / kidneys in Eurotransplant in 2009 43
Figure 4.1 Kidney waiting list, number of patients at year end, by urgency 44
Figure 4.2 Kidney waiting list, percentage of patients at year end, by urgency 44
Table 4.2(i) Active kidney transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 44
Table 4.2(ii) Active kidney transplant waiting list, as per December 31 , 2009 - characteristics 45
Table 4.3(i) Active kidney-only transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 45
Table 4.3(ii) Active kidney-only transplant waiting list, as per December 31, 2009 - characteristics 45
Figure 4.3 Number of deceased donor kidney transplants, by recipient urgency at transplant 46
Figure 4.4 Percentage of deceased donor kidney transplants, by recipient urgency at transplant 47
Table 4.4(i) Kidney transplant characteristics from 2005 to 2009 47
Table 4.4(ii) Kidney transplant characteristics - 2009 48
Table 4.5(i) Living donor kidney transplants - kidney-only from 2005 to 2009 49
Table 4.5(ii) Living donor kidney transplants - kidney-only - 2009 50
Figure 4.5 Dynamics of the Eurotransplant kidney transplant waiting list and transplants between 1969 and 2009 50
5. ThoracIc organs: donaTIon, waITIng lIsTs and TransplanTs 51
Table 5.1(i) Deceased donors / hearts in Eurotransplant from 2005 to 2009 51
Table 5.1(ii) Deceased donors / hearts in Eurotransplant in 2009 51
Table 5.2(i) Deceased donors / lungs in Eurotransplant from 2005 to 2009 51
Table 5.2(ii) Deceased donors / lungs in Eurotransplant in 2009 52
Figure 5.1 Heart waiting list, number of patients at year end, by urgency 52
Figure 5.2 Heart waiting list, percentage of patients at year end, by urgency 53
Table 5.3(i) Active heart transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 53
Table 5.3(ii) Active heart transplant waiting list as per December 31, 2009 - characteristics 53
Table 5.4(i) Active heart-only transplant waiting list as per December 31 - characteristics 53
Table 5.4(ii) Active-heart only transplant waiting list as per December 31, 2009 - characteristics 54
Table 5.5(i) Active heart + lung transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 54
Table 5.5(ii) Active heart + lung transplant waiting list, as per December 31, 2009 - characteristics 55
Table 5.6(i) Active heart + lung transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 55
Table 5.6(ii) Active heart + lung transplant waiting list as per December 31, 2009 - characteristics 55
Figure 5.3 Lung waiting list, number of patients at year end, by urgency 56
Figure 5.4 Lung waiting list, percentage of patients at year end, by urgency 56
Table 5.7(i) Active lung transplant waiting list as per December 31, from 2005 to 2009 - characteristics 57
Table 5.7(ii) Active lung transplant waiting list as per December 31, 2009 - characteristics 57
Table 5.8(i) Active lung-only transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 57
Table 5.8(ii) Active lung-only transplant waiting list, as per December 31, 2009 - characteristics 57
Figure 5.5 Number of deceased donor heart transplants, by recipient urgency at transplant 58
Figure 5.6 Percentage of deceased donor heart transplants, by recipient urgency at transplant 59
Table 5.9(i) Heart transplants from 2005 to 2009 - characteristics 59
Table 5.9(ii) Heart transplants 2009 - characteristics 60
Table 5.10(i) Heart + lung transplants from 2005 to 2009 - characteristics 60
Table 5.10(ii) Heart + lungs transplants 2009 - characteristics 61
Figure 5.7 Number of deceased donor lung transplants, by recipient urgency at transplant 62
Figure 5.8 Percentage of deceased donor lung transplants, by recipient urgency at transplant 62
Table 5.11(i) Lung transplants from 2005 to 2009 - characteristics 62
Table 5.11(ii) Lung transplants 2009 - characteristics 63
4
6. Figure 5.9 Dynamics of the Eurotransplant heart waiting list and transplants between 1991 and 2009 64
Figure 5.10 Dynamics of the Eurotransplant heart + lung waiting list, heart + lung transplants, lung waiting list and 64
lung transplants, between 1991 and 2009
6. lIvEr and InTEsTInE: donaTIon, waITIng lIsTs and TranplanTs 65
Table 6.1(i) Deceased donors / livers in Eurotransplant from 2005 to 2009 65
Table 6.1(ii) Deceased donors / livers in Eurotransplant in 2009 65
Figure 6.1 Liver waiting list, number of patients at year end, by urgency 66
Figure 6.2 Liver waiting list, percentage of patients at year end, by urgency 66
Table 6.2(i) Active liver transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 67
Table 6.2(ii) Active liver transplant waiting list, as per December 31, 2009 - characteristics 67
Table 6.3(i) Active liver-only transplant waiting list as per December 31, from 2005 to 2009 - characteristics 67
Table 6.3(ii) Active liver-only transplant waiting list as per December 31, 2009 - characteristics 68
Figure 6.3 Number of deceased donor liver transplants, by recipient urgency at transplant 68
Figure 6.4 Percentage of deceased donor liver transplants, by recipient urgency at transplant 69
Table 6.4(i) Liver transplants from 2005 to 2009 - characteristics 69
Table 6.4(ii) Liver transplants 2009 - characteristics 70
Table 6.5(i) Living donor liver transplants - liver-only - from 2005 to 2009 70
Table 6.5(ii) Living donor liver transplants - liver-only - 2009 71
Figure 6.5 Dynamics of the Eurotransplant liver waiting list and liver transplants between 1991 and 2009 72
- Intestine transplants 2009 73
Table 6.6 Number of intestinal transplants in 2009 73
7. pancrEas and IslETs: donaTIon,waITIng lIsTs and TransplanTs 74
Table 7.1(i) Deceased donors / pancreas in Eurotransplant from 2005 to 2009 74
Table 7.1(ii) Deceased donors / pancreas in Eurotransplant in 2009 74
Figure 7.1 Pancreas waiting list, number of patients at year end, by urgency 75
Figure 7.2 Pancreas waiting list, percentage of patients at year end, by urgency 75
Table 7.2(i) Active pancreas transplant waiting list as per December 31, from 2005 to 2009 - characteristics 75
Table 7.2(ii) Active pancreas transplant waiting list as per December 31, 2009 - characteristics 76
Table 7.3a(i) Active pancreas-only transplant waiting list as per December 31, from 2005 to 2009 - characteristics 76
Table 7.3a(ii) Active pancreas-only transplant waiting list as per December 31, 2009 - characteristics 76
Table 7.3b(i) Active kidney + pancreas transplant waiting list as per December 31, from 2005 to 2009 - characteristics 77
Table 7.3b(ii) Active kidney + pancreas transplant waiting list as per December 31, 2009 - characteristics 77
Figure 7.3 Number of deceased donor pancreas transplants, by recipient urgency at transplant 78
Figure 7.4 Percentage of deceased donor pancreas, by recipient urgency at transplant 79
Table 7.4a(i) Pancreas transplants 2005 to 2009 - characteristics 79
Table 7.4a(ii) Pancreas transplants 2009 - characteristics 80
Table 7.4b(i) Pancreas islet transplants, from 2005 to 2009 80
Table 7.4b(ii) Pancreas islet transplants in 2009 80
Table 7.4c(i) Pancreas transplants from 2005 to 2009 - characteristics 81
Table 7.4c(ii) Pancreas transplants 2009 - characteristics 81
Figure 7.5 Dynamics of the Eurotransplant pancreas+kidney and islet+kidney waiting list, pancreas+kidney, 82
islet+kidney, pancreas and islet-only transplants between 1991 and 2009
8. hIsTocompaTIBIlITy TEsTIng 83
8.1 Introduction 83
8.2 Eurotransplant External Proficiency Testing Schemes 83
8.2.1 External Proficiency Testing on HLA typing 83
8.2.2 External Proficiency Testing on cross matching 83
Table 8.1 Report of the crossmatch results (DTT = dithiothreitol). 84
8.2.3 External Proficiency Testing Exercise on screening 84
Table 8.2 Analysis of the data reported by the participants with respect to HLA antigens recognized (=specificities) 84
8.3 Program for the highly sensitized patients in Eurotransplant 84
Table 8.3 Evolution of the Acceptable Mismatch Program 85
8.4 Other activities 85
5
7. 9. scIEnTIfIc ouTpuT In 2009 86
- Publications - Articles / Abstracts 86
- Invited Lectures 88
- Chairmenships 89
- Oral Presentations 90
- Poster Presentations 91
10. EuroTransplanT pErsonnEl rElaTEd sTaTIsTIcs 92
11. aBBrEvIaTEd fInancIal sTaTEmEnTs 93
- Balance sheet 93
- Statement of income and charges 93
- Appropriation of the exploitation balance 94
- Accounting policies 94
- Principles of valuation of assets and liabilities 94
- Principles for the determination of the result 95
lIsT of aBBrEvIaTIons 96
6
8. Board of Eurotransplant
International foundation
as per December 31, 2009
Prof.Dr. B. Meiser, Munich president + on behalf of the thoracic section (A)
Prof.Dr. A.P.W.P. van Montfort, Utrecht secretary / treasurer (D)
Prof.Dr. U. Heemann, Munich on behalf of the kidney section (A)
Prof.Dr. F. Mühlbacher, Vienna on behalf of the kidney section (A)
Prof.Dr. D. Ysebaert, Antwerp on behalf of the kidney section (A)
Prof.Dr. W. Schareck, Rostock on behalf of the pancreas section (A)
Prof.Dr. G. Laufer, Innsbruck on behalf of the thoracic section (A)
Prof.Dr. D. Van Raemdonck, Leuven on behalf of the thoracic section (A)
Prof.Dr. K-W. Jauch, Munich on behalf of the liver section (A)
Prof.Dr. X. Rogiers, Ghent on behalf of the liver section (A)
Prof.Dr. C. Süsal, Heidelberg on behalf of the tissue typing section (A)
Prof.Dr. P. Schotsmans, Leuven ethics advisor (D)
Prof.Dr. R. Steininger, Vienna on behalf of the Austrian Transplant Society (B)
Prof.Dr. R. Troisi, Ghent on behalf of the Belgian Transplant Society (B)
Prof.Dr. R. Porte, Groningen on behalf of the Dutch Transplant Society (B)
VACANCY on behalf of the German Transplant Society (B)
Dr. V. Sojar, Ljubljana on behalf of the Slovenian Transplant Society (B)
Dr. M. Bušić, Zagreb on behalf of the Republic of Croatia (B)
Prof.Dr. F.H.J. Claas, Leiden on behalf of the Eurotransplant Reference Laboratory (C)
The Board of Stichting Eurotransplant International Foundation consists of:
10 members A: members representing organ / tissue typing sections
6 members B: members representing national transplant societies
1 member C: head of the Eurotransplant Reference Laboratory
2 members D: one member being financial expert, one member representing society (ethicist)
7
9. transplant programs anD their Delegates in 2009
Definitions
(according to Articles of Association of Stichting Eurotransplant International Foundation, version September 14, 2007)
Program:
Any of the following transplantation areas:
kidney, heart, lungs, liver, intestine, pancreas or any part of a specific organ and/or Tissue Typing, which have the
approval of the competent and relevant authorities. (Article 2)
Delegate:
Each center shall have the right to delegate one natural person in the Assembly for each program in which it performed
transplantations during a year. On each reference date, the number of persons delegated (the “delegates”) by a center in
the Assembly shall be reviewed. (Article 5.1)
(If no name is indicated, then no delegate was appointed by transplant/tissue typing program or it concerns a new
program in 2009)
renal programs Delegate
Austria
GA Medizinische Universitätsklinik, Graz S. Horn
IB Chirurgische Universitätsklinik, Innsbruck C. Bösmüller
OE Krankenhaus der Elisabethinen, Linz
OL Allgemeines Krankenhaus, Linz E. Pohanka
WG Universitätsklinik für Chirurgie, Wien F. Mühlbacher
Belgium
AN Universitair Ziekenhuis Antwerpen, Edegem D. Ysebaert
BJ Universitair Ziekenhuis Brussel, Campus Jette J. Sennesael
BR ULB, Hôpital Erasme, Bruxelles D. Abramowicz
GE Universitair Ziekenhuis, Gent P. Peeters
LA Cliniques Universitaires St. Luc, Bruxelles M. Mourad
LE Kinderdialyse Universitair Ziekenhuis Gasthuisberg, Leuven R. Van Damme-Lombaerts
LG Centre Hospitalier Universitaire, Liège
LM Universitair Ziekenhuis Gasthuisberg, Leuven Y. Vanrenterghem
Germany
AK Universitätsklinikum der Rheinisch-Westfälischen TH, Aachen A. Homburg
AU Zentralklinikum, Augsburg H. Weihprecht
BB Ruhr Universität, Bochum P. Schenker
BC Charité-Campus Virchow Klinikum der Humboldt Universität, Berlin
BE Universitätsklinikum Benjamin Franklin, Berlin M. van der Giet
BM Kliniken der Freien Hansestadt, Bremen F. Zantvoort
BO Klinikum der Urologischen und Medizinischen Universität, Bonn R. Woitas
DR Technischen Universität, Dresden S. Leike
DU Med. Einrichtungen der Heinrich-Heine-Universität, Düsseldorf K. Ivens
ER/NB Med. Einrichtungen der Universität Erlangen-Nürnberg, Erlangen K. Pressmar
ES Universitätsklinikum, Essen O. Witzke
FD Klinikum Fulda, Fulda
FM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt E. Scheuermann
FR Klinikum der Albert-Ludwigs-Universität, Freiburg P. Pisarski
GI Klinikum der Justus-Liebig-Universität, Gießen F. Renner
GO Klinikum der Georg-August-Universität, Göttingen A. Obed
HA Klinikum der Martin-Luther-Universität, Halle A. Hamza
HB Klinikum der Ruprecht-Karls-Universität, Heidelberg C. Morath
HG Universitäts-Krankenhaus Eppendorf, Hamburg F. Thaiss
HM Nephrologisches Zentrum Niedersachsen, Hann. Münden V. Kliem
HO Klinikum der Medizinischen Hochschule, Hannover F. Lehner
HS Klinikum der Universität des Saarlandes, Homburg/Saar U. Sester
JE Klinikum der Friedrich-Schiller-Universität, Jena U. Ott
8
10. KI Klinikum Christian-Albrechts-Universität, Kiel F. Braun
KL Klinik der Universität Köln-Lindenthal, Köln W. Arns
KM Kliniken der Stadt Köln gGmbH, Krankenhaus Merheim, Köln-Merheim, Köln W. Arns
KK Klinik und Poliklinik für Kinderheilkunde der Universität Köln-Lindenthal, Köln W. Arns
KS Westpfalz-Klinikum, Kaiserslautern Th. Rath
LP Klinikum der Universität, Leipzig M. Bartels
LU Klinikum der Medizinischen Universität, Lübeck M. Nitschke
MA Klinikum der Stadt, Mannheim P. Schnülle
MH Klinikum Rechts der Isar der Technischen Universität, München U. Heemann
ML Klinikum Großhadern der Ludwig-Maximilians-Universität, München K.-W. Jauch
MN Klinikum der Westfälischen Wilhelms-Universität, Münster H. Wolters
MR Klinikum Lahnberge der Philipps-Universität, Marburg J. Hoyer
MZ Klinikum der Johannes-Gutenberg-Universität, Mainz O. Schreiner
RB Klinikum der Universität, Regensburg B. Banas
RO Klinikum der Universität, Rostock O. Hakenberg
ST Katharinenhospital, Stuttgart J. Wilhelm
TU Klinikum der Eberhard-Karls-Universität, Tübingen S. Nadalin
UL Klinikum der Universität, Ulm M. Wittau
WZ Klinikum der Julius-Maximilians-Universität, Würzburg K. Lopau
Luxembourg
LX Centre Hospitalier de Luxembourg P. Duhoux
The Netherlands
AV VU Medisch Centrum, Amsterdam S. Nurmohamed
AW Academisch Medisch Centrum, Amsterdam F. Bemelman
GR Academisch Ziekenhuis, Groningen J. Homan van der Heide
LB Leids Universitair Medisch Centrum, Leiden J. de Fijter
MS Academisch Ziekenhuis, Maastricht M. Christiaans
NY Universitair Medisch Centrum St. Radboud, Nijmegen A. Hoitsma
RD Erasmus Medisch Centrum, Rotterdam W. Weimar
RS Sophia Kinderziekenhuis, Rotterdam K. Cransberg
UT Universitair Medisch Centrum, Utrecht A. van Zuilen
UW Wilhelmina Kinderziekenhuis, Utrecht M. Lilien
Slovenia
LO University Medical Center, Ljubljana D. Kovač
Croatia
OS University Hospital, Osijek J. Galić
RI University Clinical Hospital, Rijeka L. Orlić
ZA University Clinical Cospital, Zagreb J. Pasini
ZM Clinical Hospital Zagreb Merkur, Zagreb M. Knotek
heart programs Delegate
Austria
GA Chirurgische Universitätsklinik, Graz A. Wasler
IB Chirurgische Universitätsklinik, Innsbruck L. Müller
WG Universitätsklinik für Chirurgie, Wien A. Zuckermann
Belgium
AN Universitair Ziekenhuis Antwerpen, Edegem I. Rodrigus
AS Onze Lieve Vrouw Ziekenhuis, Aalst I. Deblier
BR Université Libre de Bruxelles, Hôpital Erasme, Bruxelles M. Antoine
GE Universitair Ziekenhuis, Gent F. Caes
LA Cliniques Universitaires St. Luc, Bruxelles A. Poncelet
LG Centre Hospitalier Universitaire, Liège J. Defraigne
LM Universitair Ziekenhuis Gasthuisberg, Leuven J. Vanhaecke
9
11. Germany
AK Universitätsklinikum der Rheinisch-Westfälischen TH, Aachen A. Moza
BA Herz- & Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen U. Schulz
BD Deutsches Herzzentrum, Berlin
BH Kerckhoff Klinik, Bad Nauheim M. Richter
DR Universitätsklinikum Carl Gustav Carus, Dresden S. Brose
ER/NB Med. Einrichtungen der Universität Erlangen-Nürnberg, Erlangen R. Tandler
ES Universitätsklinikum, Essen M. Kamler
FM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt M. Scherer
FR Klinikum der Albert-Ludwigs-Universität, Freiburg F. Beyersdorf
GI Klinikum der Justus-Liebig-Universität, Gießen J. Bauer
GO Klinikum der Georg-August-Universität, Göttingen
HB Klinikum der Ruprecht-Karls-Universität, Heidelberg
HG Universitäts-Krankenhaus Eppendorf, Hamburg F. Wagner
HO Klinikum der Medizinischen Hochschule, Hannover A. Simon
HS Klinikum der Universität des Saarlandes, Homburg/Saar F. Langer
JE Klinikum der Friedrich-Schiller-Universität, Jena A. Lichtenberg
KI Klinikum der Christian-Albrechts-Universität, Kiel A. Reinecke
KL Klinik der Universität Köln-Lindenthal, Köln Th. Wittwer
LP Klinikum der Universität, Leipzig M. Barten
MD Deutsches Herzzentrum, München
ML Klinikum Großhadern der Ludwig-Maximilians-Universität, München B. Meiser
MN Klinikum der Westfälischen Wilhelms-Universität, Münster S. Klotz
MZ Klinikum der Johannes-Gutenberg-Universität, Mainz U. Mehlhorn
RB Klinikum der Universität, Regensburg S. Hirt
WZ Universitätsklinikum, Würzburg V. Lange
The Netherlands
GR Academisch Ziekenhuis, Groningen J. Brügemann
RD Erasmus Medisch Centrum, Rotterdam A. Maat
UT Universitair Medisch Centrum, Utrecht N. de Jonge
Slovenia
LO University Medical Center, Ljubljana I. Knezević
Croatia
ZA University clinical hospital, Zagreb D. Milicic
ZD Clinical Hospital Dubrava, Zagreb Z. Sutlic
lung programs Delegate
Austria
IB Chirurgische Universitätsklinik, Innsbruck L. Müller
WG Universitätsklinik für Chirurgie, Wien A. Zuckermann
Belgium
AN Universitair Ziekenhuis Antwerpen, Edegem P. Van Schil
BR ULB, Hôpital Erasme, Bruxelles M. Estenne
LA Cliniques Universitaires St. Luc, Bruxelles P. Evrard
LM Universitair Ziekenhuis Gasthuisberg, Leuven D. Van Raemdonck
Germany
BD Deutsches Herzzentrum, Berlin
DR Universitätsklinikum Carl Gustav Carus, Dresden S. Brose
ES Universitätsklinikum, Essen M. Kamler
FR Klinikum der Albert-Ludwigs-Universität, Freiburg A. Kirschbaum
GI Klinikum der Justus-Liebig-Universität, Gießen R. Schulz
HG Universitäts-Krankenhaus Eppendorf, Hamburg F. Wagner
HO Klinikum der Medizinischen Hochschule, Hannover A. Simon
HS Klinikum Universität des Saarlandes, Homburg/Saar
10
12. JE Klinikum der Friedrich-Schiller-Universität, Jena M. Breuer
KI Klinikum der Christian-Albrechts-Universität, Kiel
LP Klinikum der Universität, Leizpig H. Bittner
ML Klinikum Großhadern der Ludwig-Maximilians-Universität, München B. Meiser
MN Klinikum der Westfälischen Wilhelms-Universität, Münster
MZ Klinikum der Johannes-Gutenberg-Universität, Mainz M. Dahm
The Netherlands
GR Academisch Ziekenhuis, Groningen M. Erasmus
RD Erasmus Medisch Centrum, Rotterdam J. Bekkers
UT Universitair Medisch Centrum, Utrecht E. van de Graaf
liver programs Delegate
Austria
GA Chirurgische Universitätsklinik, Graz F. Iberer
IB Chirurgische Universitätsklinik, Innsbruck W. Mark
WG Universitätsklinik für Chirurgie, Wien R. Steininger
Belgium
AN Universitair Ziekenhuis Antwerpen, Edegem D. Ysebaert
BR ULB, Hôpital Erasme, Bruxelles V. Donckier
GE Universitair Ziekenhuis, Gent X. Rogiers
LA Cliniques Universitaires St. Luc, Bruxelles J. Lerut
LG Centre Hospitalier Universitaire, Liège O. Detry
LM Universitair Ziekenhuis Gasthuisberg, Leuven J. Pirenne
Germany
BC Charité-Campus Virchow Klinikum der Humboldt Universität, Berlin D. Seehofer
BO Chirurgische Universitätsklinik, Bonn N. Speidel
ER/NB Chirurgische Klinik der Universität Erlangen-Nürnberg, Erlangen V. Müller
ES Universitätsklinikum, Essen A. Paul
FM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt C. Mönch
GO Klinikum der Georg-August-Universität, Göttingen A. Obed
HB Klinikum der Ruprecht-Karls-Universität, Heidelberg J. Schmidt
HG Universitäts-Krankenhaus Eppendorf, Hamburg L. Fischer
HO Klinikum der Medizinischen Hochschule, Hannover Th. Becker
HS Klinikum Universität des Saarlandes, Homburg/Saar O. Kollmar
JE Friedrich Schiller Universität, Jena U. Settmacher
KI Klinikum der Christian-Albrechts-Universität, Kiel F. Braun
KL Klinik der Universität Köln-Lindenthal, Köln D. Stippel
LP Klinikum der Universität, Leipzig S. Jonas
MB Klinikum Otto-von-Guericke Universität, Magdeburg H. Lippert
MH Klinikum Rechts der Isar der Technischen Universität, München P. Büchler
ML Klinikum Großhadern der Ludwig-Maximilians-Universität, München K.-W. Jauch
MN Klinikum der Westfälischen Wilhelms-Universität, Münster H. Wolters
MZ Klinikum der Johannes-Gutenberg-Universität, Mainz M. Heise
RB Klinikum der Universität, Regensburg M. Scherer
TU Klinikum der Eberhard-Karls Universität, Tübingen S. Nadalin
The Netherlands
GR Academisch Ziekenhuis, Groningen R. Porte
LB Leids Universitair Medisch Centrum, Leiden J. Ringers
RD Erasmus Medisch Centrum, Rotterdam G. Kazemier
Slovenia
LO University Medical Centre, Ljubljana S. Markovič
11
13. Croatia
ZA University Clinical Hospital, Zagreb
ZM Clinical Hospital Merkur, Zagreb B. Kocman
ZP University Clinical Hospital Pediatric, Zagreb
pancreas (islet) programs Delegate
Austria
GA Chirurgische Universitätsklinik, Graz F. Iberer
IB Chirurgische Universitätsklinik, Innsbruck W. Mark
WG Universitätsklinik für Chirurgie, Wien F. Mühlbacher
Belgium
AN Universitair Ziekenhuis Antwerpen, Edegem D. Ysebaert
BR ULB, Hôpital Erasme, Bruxelles A. Hoang
BP Academisch Ziekenhuis der Vrije Universiteit, Brussel D. Pipeleers
GE Universitair Ziekenhuis, Gent C. Randon
LA Cliniques Universitaires St. Luc, Bruxelles L. De Pauw
LG Centre Hospitalier Universitaire, Liège
LM Universitair Ziekenhuis Gasthuisberg, Leuven
Germany
BB Knappschaftskrankenhaus, Bochum P. Schenker
BC Charité-Campus Virchow Klinikum der Humboldt Universität, Berlin A. Kahl
DR Universitätsklinikum Carl Gustav Carus, Dresden S. Kersting
ER/NB Chirurgische Klinik der Universität Erlangen-Nürnberg, Erlangen V. Müller
ES Universitätsklinikum, Essen A. Paul
FM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt C. Mönch
FR Klinikum der Albert-Ludwigs-Universität, Freiburg P. Pisarski
HB Klinikum der Ruprecht-Karls-Universität, Heidelberg J. Schmidt
HG Universitäts-Krankenhaus Eppendorf, Hamburg L. Fischer
HO Klinikum der Medizinischen Hochschule, Hannover Th. Becker
JE Friedrich Schiller Universität, Jena U. Settmacher
KI Klinikum der Christian-Albrechts-Universität, Kiel F. Braun
KL Klinik der Universität Köln-Lindenthal, Köln D. Stippel
KM Kliniken der Stadt Köln gGmbH, Krankenhaus Merheim, Köln-Merheim, Köln D. Stippel
LP Klinikum der Universität, Leipzig D. Uhlmann
LU Klinikum der Medizinischen Universität, Lübeck
MH Klinikum Rechts der Isar der Technischen Universität, München P. Büchler
ML Klinikum Großhadern der Ludwig-Maximilians-Universität, München H. Arbogast
MR Klinikum Lahnberge der Philipps-Universität, Marburg J. Hoyer
MZ Klinikum der Johannes-Gutenberg-Universität, Mainz M. Heise
RB Klinikum der Universität, Regensburg S. Farkas
RO Klinikum der Universität, Rostock E. Klar
TU Klinikum der Eberhard-Karls-Universität, Tübingen S. Nadalin
The Netherlands
GR Academisch Ziekenhuis, Groningen R. Ploeg
LB Leids Universitair Medisch Centrum, Leiden J. Ringers
Croatia
ZM Clinical Hospital Merkur, Zagreb S. Jadrijević
tissue typing laboratories Delegate
Austria
GA Universitätsklinik, Abteilung für Transfusionsmedizin und Immunohämatologie, Graz A. Helmberg
IB Universitätsklinik, HLA Labor, Innsbruck A. Mühlbacher
12
14. OL Allgemeines Krankenhaus, Blutzentrale, Linz C. Gabriel
OW Allgemeines Krankenhaus, HLA Labor, Wels R. Loizenbauer
WG Institut für Blutgruppenserologie, Wien W. Mayr
Belgium
BJ Universitair Ziekenhuis Brussel, Bloedtransfusiecentrum Jette C. Demanet
BR Hôpital Erasme, Tissue typing laboratory, Bruxelles M. Andrien
LA Université de Louvain, Tissue typing laboratory, Bruxelles D. Latinne
LG Laboratoire des Groupes Sanguins, Liège G. Maggipinto
ME Rode Kruis Vlaanderen, Laboratory for Histocompatibility & Immunogenetics (HILA), Mechelen M.-P. Emonds
Germany
BC Charité-Campus Virchow Klinikum der Humboldt Universität, Berlin C. Schönemann
DU Institut für Transplantationsdiagnostik und Zelltherapeutika, Düsseldorf J. Rox
ER/NB Institut für Klinische Immunologie, Erlangen B. Spriewald
ES Universitätsklinikum, Institut für Immunologie, Essen F. Heinemann
FM Immunohaematologie, Blutspendedienst Hessen, Frankfurt C. Seidl
FR Blutspendedienst, Labor für Gewebetypisierung, Freiburg F. Emmerich
GI Institut für Klinische Immunologie und Transfusionsmedizin, Gießen S. Wienzek
GO Klinikum der Universität, HLA Labor, Göttingen H. Neumeyer
HA Institut für Phathologische Biochemie, Interdisziplinäres Typisierungslabor, Halle W. Altermann
HB Institut für Immunologie und Serologie, Heidelberg C. Süsal
HG Universitäts-Krankenhaus Eppendorf, HLA Labor, Hamburg T. Binder
HO Klinikum der Medizinischen Hochschule, Immunohaematologie/Blutbank, Hannover M. Hallensleben
KI Klinikum der Christian-Albrechts-Universität, HLA Labor, Kiel M. Marget
KM Institut für Transfusionsmedizin, Köln-Merheim, Köln U. Bauerfeind
KS Institut für Rechtsmedizin, Transplantationsimmunologie, Kaiserslautern B. Thiele
LU Institut für Immunologie und Transfusionsmedizin, Lübeck M. Ziemann
ML Kinderklinik der Ludwig-Maximilians-Universität, HLA Labor, München M. Spannagl
GMN Institut für Transfusionsmedizin, Münster
MZ Klinikum der Johannes-Gutenberg Universität, HLA Labor, Mainz W. Hitzler
RO Klinikum der Universität, Abteilung für Transfusionsmedizin, HLA Labor, Rostock
ST Klinikum Stuttgart, Zentralinstitut für Transfusionsmedizin und Blutspendedienst, Stuttgart A. Ender
TU Klinikum der Eberhard-Karls-Universität, Abt. für Transfusionswesen und Blutbank, Tübingen
UL DRK Blutspendezentrale, Transplantationsimmunologie, Ulm J. Mytilineos
Luxembourg
LX Centre Hospitalier, HLA Lab, Luxembourg F. Hentges
The Netherlands
AW Centraal Laboratorium Bloedtransfusiedienst, Nederlandse Rode Kruis, Amsterdam N. Lardy
GR Laboratorium voor transplantatie-immunologie, Groningen S. Lems
LB Leiden University Medical Centre, Immunohaematologie, Leiden F. Claas
MS Academisch Ziekenhuis, Laboratorium voor weefseltypering, Maastricht M. Tilanus
NY Academisch Ziekenhuis St. Radboud, Bloedtransfusiedienst, Nijmegen W. Allebes
UT Academisch Ziekenhuis, Bloedbank, Utrecht H. Otten
Slovenia
LO Tissue Typing Centre, Blood Transfusion Centre, Ljubljana B. Vidan-Jeras
Croatia
RI Clinical Hospital Center, Tissue Typing Laboratory, Rijeka N. Katalinić
ZA University Clinical Hospital, Zagreb R. Zunec
ETRL Eurotransplant Reference Laboratory, Leids Universitair Medisch Centrum, Leiden, The Netherlands
F. Claas, I. Doxiadis
13
16. foreword
We hereby present to you the Annual Report report of 2009 of the Eurotransplant (ET) International Foundation. The objective
of this report is to be accountable for the activities and initiatives that were undertaken in 2009 in Austria, Belgium, Croatia,
Germany, Luxembourg, the Netherlands and Slovenia towards the internal and external parties with a vested interest in the
Foundation such as:
• the national regulating transplant authorities;
• the national representatives of the transplant societies;
• the financing authorities;
• the donor hospitals;
• the transplant centers;
• the tissue typing laboratories;
• the employees of the ET office.
As always, many people have worked systematically to achieve our mission to encourage organ transplantation and to reach
the goals associated with its mission. Obviously the good work was done by doctors and nurses of the donor hospitals and
the transplant centers, the tissue typers, the transplant coordinators and many others such as people working at the ET office.
Our Advisory Committee members put a lot of time and effort in setting organ allocation- and procurement as well as ethical,
financial and ICT standards. We gratefully thank all people involved!
ET conducted many activities in line with the steps described in the ET Policy Plan 2009-2013. Our objectives were to address
the organizational issues and risks that were identified in this plan in order to prepare our organization adequately for the
future. Also, following the request of two potential new member states, discussions on possibilities to cooperate were started
with the republics of Estonia and Serbia.
Finally, we hope – with support from all of you – to realize as many as possible challenging achievements in the year 2010!
Prof.Dr. Bruno Meiser Dr. Axel Rahmel Arie Oosterlee, MD MBA
President Medical Director General Director
Leiden, April 2010
15
17. 1. report of the Board and the
central office of Stichting
Eurotransplant International (ET)
foundation
E. Houwaart, R. Cranendonk and A. Oosterlee, Eurotransplant International Foundation, the Netherlands
The Board of Stichting Eurotransplant International Foundation met on January 22, May 18 and September 30 & October
2, 2009. Three Board members A were (re)-elected by the Assembly. Prof.Dr. Uwe Heemann and Prof.Dr. Caner Süsal were
elected as members A in the kidney and tissue typing section respectively. Prof.Dr. Günther Laufer was re-elected in the
thoracic section. The Board took leave of Prof.Dr. Rutger Ploeg and Dr. Joannis Mytilineos. Prof.Dr. Guus van Montfort was
re-elected by the Board as a member D in the field of finance. Prof.Dr. Uwe Heemann was elected as chairman of the ETKAC
in succession to Prof.Dr. Hans de Fijter.
1.1 report of the eurotransplant board
During its first meeting in 2009, the Board continued the discussion on the position of the intestine in relation to the organ
allocation sequence. It was explained that due to the fact that from pediatric organ donors only either the pancreas or the
intestine can be offered, pediatric patients awaiting an intestine transplantation are in a disadvantage. The discussion resulted
in the formulation of an interim solution [RET01.09 (ad int)] firstly to be discussed by the ELIAC and the EPAC.
Reviewing the minutes of the Board meeting, the Board recognized that some topics concern several Advisory Committees.
It was therefore decided to organize one meeting with all ET Advisory Committees and the Board of ET in order to discuss
new recommendations and changes in a transparent and time efficient way. This joint meeting was organized for the first time
on October 2, 2009 in conjunction with the annual ET meeting. The meeting was considered to be an opportunity to discuss
topics from different perspectives, which might lead to valuable new insights. One of the topics discussed was the above
mentioned pancreas/intestine procurement and rescue allocation. With regard to pancreas/intestine procurement, the Board
decided to take a decision on RET01.09 (ad int.) during the Board meeting in Alpbach, Austria on January 27, 2010.
During the year 2009, the Board was informed about the progress of several projects:
EFRETOS
The Board was informed on the progress of the European FRamework for the EvaluaTion of Organ transplantS (EFRETOS –
www.efretos.org). The general objective of this project is to evaluate the results of transplantation, by promoting a registry of
registries on the follow-up of organ recipients. The project officially started in May 2009 after a kick-off meeting which was
attended by all leaders of the work packages. Completion of the project was expected to be a fact within 24 months.
Friends of Eurotransplant
The Board approved the constitution of the Board of the Friends of Eurotransplant Foundation, in which initially four members
have a seat. The Board will continue to search for further Board members of the Friends of Eurotransplant Foundation.
Implementation of the ET general conditions
During the first 2009 meeting, the Board was informed that one ET country had not yet accepted and another had only
acknowledged the general conditions. The general conditions are important to ET as in these conditions the distribution of
responsibilities and thus liabilities between ET and the transplant centers are clearly defined (e.g. the centers rather than ET are
responsible for patient data in the ET waiting lists). In the course of the year, the chairman of the German Bundesärztekammer
informed ET that the general conditions contain two issues that cannot be approved by Germany. These issues concern
limitation of liability and the fact in case of a dispute the Dutch law is valid. Subsequently, discussions took place in order to
find a solution which resulted in a new draft of the general conditions. German approval of this version is still pending.
16
18. The possible hosting of an ISHLT database and setting up a VAD registry project was postponed. The current global financial
crisis made the ISHLT decide not to initiate any new projects for the time being.
The Board several times discussed the entering of potential ET member states. There had been contacts with several European
countries – among others Estonia and Serbia – in order to establish possible cooperation. This is a continuing process, on
which the Board will be kept updated. ET will furthermore research the possibility to get official support by EU for opening
up to new countries.
A representative of the Estonian transplant community had been invited to one of the Board meetings to give a presentation
on the Estonian organ donation and transplantation system. This presentation resulted in the Board agreement to go ahead
with negotiating on a possible cooperation with Estonia.
The Serbian Minister of Health was invited to another Board meeting to give a presentation on the Serbian organ donation
and transplantation system. It was decided to also continue the establishment of cooperation with Serbia and to evaluate
the progress during the Board meeting in Alpbach, Austria on January 27, 2010. Furthermore, the Board decided that other
European countries will be visited in order to set up or maintain relations and research the possibility for cooperation.
In view of these possible entries of potential member states, the Board agreed upon a list of prerequisites for preliminary
cooperation.
The establishment of cooperation with potential new ET member states also resulted in the idea of setting up an ET college
for the training of medical professionals in the field of organ donation and transplantation. It was decided to bring this issue
forward to the Council of ESOT and investigate the possibility for cooperation.
The Eurotransplant Information Exchange Platform (EuTIEP) met three times. During these meetings presentations from all
ET countries and Spain were given. The purpose of information exchange had been fulfilled and there was no need to continue
the platform. In order to maintain a direct communication structure with the competent national authorities within ET, the
Board accepted the proposal to install an ET Council in which the Board of ET and these authorities are represented.
The ET Council met for the first time in September 2009. The ET contract partners and the Board members B were invited to
the meeting. The participants acknowledged the council as an official body. The main topics discussed during the first meeting
were approval of the ET Basic Mandate and the expansion of the ET region.
With regard to ET’s financial situation, the Board was informed that the budget negotiations for 2009 had taken place. As
a result, ET will be able to implement the most important recommendations from ET’s policy planning project, such as
reinforcement of several departments and establishing a central communication function. The Board was also informed that
the reserves of ET increased in the course of 2009. In this respect the Board decided to further increase the reserves in the
coming years, in order to be able to deal with any unexpected events. In the course of the year 2009 the Board approved the
annual accounts 2008 as well as the final budget proposal 2009.
A new model for future budget proposals was presented to the financial authorities, which was very positively received.
This new model consists of a basic part, a project compartment and country specific parts. Only large projects will have to
be negotiated separately in the future. As a consequence of implementing this new budgetary system, it was necessary to
formalize the mandate for basic services (Basic Mandate) which ET provides to its member states.
Following the ET policy planning project a document on the Basic Mandate of ET was composed and presented to the Board.
After processing the comments of the Board members, it was decided to proceed with the development of the Basic Mandate
which has the support of all national authorities within ET. This ET Basic Mandate was approved by the ET contract partners
during the first meeting of the ET Council.
With regard to the lung transplant cooperation between Vienna and several non-ET countries, it was decided to grant the
Vienna lung transplant program an extra year for establishing twinning agreements.
The Board approved twinning agreements on lung transplantation between Vienna – Estonia, Vienna – Cyprus and Vienna
– Bratislava. The Board furthermore approved the establishment of cooperation between Vienna and Croatia regarding lung
transplantation. The aim of this cooperation is that all Croatian patients awaiting lung transplantation will be transplanted in
Vienna. All lungs from Croatian donors will be handled as local donors of the Vienna lung transplant program.
17
19. Following a request of the Belgian Transplantation Society, the Board approved support of the Belgian cross-over program
by ET.
A new version of a document on practical handling of data analysis requests including a classification overview of types of
requests was presented and approved. This overview describes which type of requests will be carried out in the framework of
ET’s Basic Mandate and which type of requests have to be paid for by the requestors. The main idea is that requests involving
substantial workload for the data analysis on the side of ET should only be done if the request is approved by the respective ET
scientific Advisory Committee. For larger projects every effort should be made to find external financial sources to compensate
for the costs involved at ET (for example by finding study sponsors). If such an external financing cannot be provided or found,
the ET Financial Committee has to approve the performance of the data analysis (and thereby the involved costs).
The format of the Henk Schippers Young Investigators (HSYI) award has changed. The Board decided to give the award to the
best paper composed by authors from the ET region and published in the last year. A selection committee had been formed
and consists of four Board members. The 2009 winner of the HSYI award was Dr. Pieter Gillard from the University Hospital,
Leuven, Belgium.
With regard to the subject of cross-border migration of Dutch and Belgian transplant patients it was decided to organize a
consensus meeting in Belgium to which all Belgian specialists in the field of organ donation and transplantation were to be
invited. Creating complete transparency is one of the major aims of this meeting.
In this respect, the idea was brought up to promote the establishment of a European social security number within the EU.
With this social security number absolute transparency can be created in the social health care provided by EU countries to
EU citizens. It will also give a clear insight in the national balances between donors and transplanted patients.
On request of the ETEC, the Board endorsed the Declaration of Istanbul and decided to send a letter to the ET transplant
centers in order to ask for their endorsement as well.
The Board decided to implement the ET Senior DR-matching (ESDP) program in the ET allocation system in the course of
2009.
It was discussed by the Board whether ET should establish a reference laboratory for virology testing. Also, since it was
determined that laboratory values vary, it was discussed whether ET should set standards for laboratory values. It was decided
to research current standards for laboratory values and to further discuss this issue in the OPC and during the ET winter
meeting in Alpbach, Austria.
In view of increasing activities in transplanting composite tissues, for example for hand or face transplantation, it was suggested
to draw the attention of the European Commission to the fact that ET has the aspiration to become the responsible organization
for allocation of hepatocytes, islets and composite grafts. Since ET has the experience and facilities for quick guidance of the
process from donation to transplantation this is considered to be a logical addition to the services ET provides.
The Board was informed about a visit by the ET medical director to the United Network for Organ Sharing in Boston, MA,
USA. UNOS is interested in cooperation with ET in respect to exchanging knowledge and experience.
1.2 Report of the Eurotransplant office
For ET, 2009 can be seen as a year in which many steps were taken to specify and further professionalize its services to
professionals as well as to national authorities. The activities directly came forth from the ‘Eurotransplant Policy Plan 2009-
2013; Phase 1: Milestone 4’. Practically all goals for 2010 were met. In some areas this was noticed and appreciated by our
users.
An important step was the formal specification of the responsibilities and main services of ET in ET’s so-called Basic
Mandate (published in chapter 2 of this Annual Report). This mandate is the point of reference for many of ET’s activities.
In the area of planning & control several steps regarding organization and responsibilities were taken. A department was
set up (Information Services) to prepare and implement policies in the field of business and information activities, which
acts as an intermediary between the primary and supportive processes. Program management was introduced and project
management was reinforced. Functional and technical application maintenance and support was restructured and the testing
process improved.
18
20. The following processes and activities are reported according to the services mentioned in the Basic Mandate.
Allocation services
The allocation process improved through reinforcement of the staff of the Medical Administration with the long term focus
of a 24/7 regular staff attendance.
An electronic donor log application was developed for registration per donor of deviations in the allocation process which
previously was done on paper. This contributes to the quality of the process and makes analysis easier.
The Donation Procedure Application (DPA) was introduced in Luxembourg.
An application to support the planned Belgian kidney living donor cross-over program was developed and made available.
Development of allocation process
In the area of data collection and analysis a ‘Registry Policy Plan’ was developed and preparations for executing the plan were
made. Meanwhile projects and pilots were started to anticipate the implementation of the policy. The European EFRETOS
project and the ET registry policy were harmonized wherever appropriate. Reinforcement of the biostatistical capacity was
started by initiating the hiring of an additional biostatistician.
A study (ESDP) on evaluating different ways of allocating kidneys of elderly (>65 years of age) donors to elderly patients
was started. Centers provide data via a web application to ET where data analysis is done.
Through the ET Registry for Islets and Pancreas (ETRIP) project a pan-European follow-up application and database for
islets and pancreas allocation was developed and implemented by December 2009, thus filling the existing gap.
External networking
In the field of external networking several important developments took place: the ET Council was established giving national
authorities a formal platform to discuss issues and concerns on a supranational level with the Board of ET. This Council met
once and formalized ET’s above mentioned Basic Mandate.
Another formal step taken was the formalization of a service level agreement (SLA) between the Nederlandse Transplantatie
Stichting (NTS) and ET. In this document the terms of the contract between ET and the NTS are annually specified. It also
distinguishes in basic and country specific services that the NTS asks ET to provide.
The ET annual meeting was organized in Leiden in October, just like it had been in the past years. The concept and venue of
ET’s winter meeting however, was changed after 25 years. In contrast to previous winter meetings, this meeting was opened
up to everyone with an interest in ET. The audience was welcomed in the professional congress center Alpbach, Tirol and was
presented with an interesting program. One element of the new concept was the inclusion of workshops into the program.
In line with ET’s 5 years strategy, the so-called Friends of Eurotransplant Foundation was registered and had its first meeting.
Friends of Eurotransplant will shortly develop an action plan for the coming period.
In the field of communication a future vision together with a detailed stepwise approach was developed with help of an
external consultant. A start was made with hiring a regular communication officer. Also a plan was developed and partially
carried out to evaluate our corporate design and the external website and member site.
Information and quality
In the field of information management, steps were taken to improve cooperation via a method of sharing documents and
preliminary steps were made on information policy and information architecture.
The ICT infrastructure was reinforced, as well as the staff supporting it. A start was made with a storage area network (SAN)
combined with virtualization of servers to increase availability and service and reduce the number of physical servers and
maintenance.
ET underwent several external audits in 2009. ET’s quality assurance system was externally audited by Veritas. Our systems
were positively evaluated. A recommendation for improvement was in the meantime been addressed. As from February 2010
ET is accredited for ISO 9001: 2008. In 2009, the German as well as the Dutch national transplant authorities audited ET’s
organization and services. Both the German ‘Prüfungskommission’ as well as the NTS determined that ET was delivering its
services according to its formal obligations.
Finance
In the financial field, steps were taken in the enhancement of systems for budgeting, reporting and costing. Budget forecasting
was increased by appointing budget responsible persons. Also the hour registration-system was adapted to get more insight.
The financial reserves of ET were replenished and a preliminary analysis of the reserves was performed aiming at a (re)
definition of reserves and reserve policy in 2010. Progress was made on workforce management and a workforce strategy
and policy.
19
21. Personnel
In 2009 a start has been made to adapt the staffing of the duty desk according to strategy. It is intended to expand this
function to each shift in the future to further assure the quality of our allocation process.
Information services
The planning and control systems for functional and technical development as well as maintenance of ET’s software
applications were given a boost this year. A function was set up for project and program management as well as test
coordination. In its short existence a significant improvement in management information was achieved which strongly
enhances prioritization, planning and decision making by the directors.
1.3 Future policy
Also in 2011, the ET Policy Plan 2009-2013 will provide guidance for developing plans and activities. The consolidation
strategy will be sustained, whereas we will remain open for discussion with countries that want to explore possibilities for
cooperating with ET.
Regarding the internal organization three related developments will specifically demand attention in the coming period:
1. Due to legislative developments in the Netherlands, the economies of scale and scope that ET experienced by sharing
personnel with two other organizations are currently under discussion.
2. As ET, NTS and NBF-BIS currently also share vital infrastructure i.e. computer hardware and software,
telecommunication equipment etc., a vision for the near future on how to develop a comprehensive separation process
will have to be developed and – after the consequences have been thoroughly assessed – implemented.
3. The lease contract for housing ends in 2011. As the ‘housing capacity’ is no longer sufficient for ET, currently
alternatives are being investigated.
1.4 Quality assurance & safety
Apart from the yearly regular quality issues, such as updating the ET-manual, the year 2009 was characterized by two
special issues.
First the implementation process of the ISO 9001:2008 regulations was continued. Secondly the evaluation of several
aspects of our internal and external communication as well as the evaluation of our incidents management system took
place. During the past two years the risk awareness of our employees significantly increased. The incident registration
system was analyzed and further developed in order to support systematic improvement of the allocation process. The
improvements will be implemented in 2010.
Safety management and patient safety
Safety management covers different area’s, such as patient safety, minimization of liability risks and financial safety. ET
services countries with different legislative systems and with certain country specific allocation rules.
In the automated matching process all these country-specific laws and rules are taken into account. The ET-manual gives a
transparent and crystal clear outline of all rules and criteria regarding every organ.
Incidents
The risk awareness of the employees further improved as the number of near-incidents and incidents identified and reported
increased (see table below). For this reason it is essential to develop a system for continuous learning, which will be
implemented in 2010.
Reported near-incidents and incidents
With an 2007 2008 2009
Internal cause 293 289 347
External cause 263 236 244
Internal & External cause 24 17 20
Total 580 542 611
20
22. Almost all of the incidents with an internal cause were incidents in incomplete administration, which led to extra
administrative operations, such as re-examining the donor log. Incidents with an external cause were discussed with the
responsible parties/persons/organizations, such as transplant coordinators and transport companies.
Complaints
Since October 1, 2008 an e-mail address (complaints@eurotransplant.org) for complaints and suggestions is placed on the
member site together with an explanation of the purpose of that e-mail address.
In 2009 eight complaints were registered; three by e-mail and five complaints were received by conventional mail. In
all cases complaints were made to ET concerning third parties. ET passed on these complaints to (national authorities,
hospital, etc) whom they concerned. All complaints were related to communication issues.
Audits by third parties
Although certification according to ISO 9001:2000 is valid for another year, ET is now certified according to ISO
9001:2008.
The yearly investigation by the German Prüfungskommission led to a satisfactory outcome.
The audit by the NTS was successful as well.
Internal audits
Besides the regular audit issues a theme audit, concerning communication, was done. Several weak points were discerned
and acted upon.
1.5 advisory committees
The Board discussions, among other issues, concentrated on the proposed recommendations by the various Advisory
Committees. Obviously, the work done in these committees contributes to improve the core of the business, namely: state of
the art allocation. The Board is grateful for all the time and efforts the Committee members have provided to this important
part of the work of ET.
ET positions itself as an independent scientifically oriented organization. Various organ Advisory Committees, of which
the chairmen hold a position in the Board of ET, meet several times a year and discuss the impact of new scientific
developments in the field of organ allocation, organ procurement as well as transplant ethics. Their conclusions are
proposed as recommendations to the Board of ET. In the respective member states national transplant authorities authorize
recommendations approved by the ET Board, sometimes with slight adaptations to the national circumstances. A complete
list of all recommendations approved in 2009 is published under section 1.6 of this chapter.
Through this practice transplant regulations throughout ET have a great degree of uniformity.
In 2009, the various Advisory Committees met 19 times and submitted 20 recommendations, 19 of which were approved
and 1 of which was postponed.
The composition of the various Advisory Committees as per December 31, 2009 was as follows:
KIDNEY ADVISORY COMMITTEE (ETKAC)
Name As of Remarks
Prof.Dr. U. Heemann, Munich 05.2009 chairman, representative Board
Prof.Dr. F. Mühlbacher, Vienna 09.1994 representative Austria
Prof.Dr. A. Rosenkranz, Innsbruck 01.2008 representative Austria
Dr. P. Duhoux, Luxembourg 09.1994 representative Luxembourg
Dr. K. Wissing, Brussels (BJ) 01.2004 representative Belgium
Dr. P. Peeters, Ghent 02.2006 representative Belgium
Vacancy 05.2009 representative Germany
Prof.Dr. U. Kunzendorf, Kiel 01.2002 representative Germany
Prof.Dr. B. Krämer, Bochum 01.2006 representative Germany
Prof.Dr. P. Fornara, Halle 11.2006 representative Germany
Dr. J. Homan van der Heide, Groningen 04.2005 representative the Netherlands
Dr. L. Hilbrands, Nijmegen 01.2006 representative the Netherlands
Dr. M. Arnol, Ljubljana 01.2006 representative Slovenia
Prof.Dr. J. Pasini, Zagreb 04.2008 representative Croatia
21
23. Prof.Dr. F.H.J. Claas, Leiden (ETRL) 09.1994 representative TT Assembly
Dr. J. de Boer, Eurotransplant 12.2005 secretary
LIVER INTESTINE ADVISORY COMMITTEE (ELIAC)
Name As of Remarks
Prof.Dr. R. Rogiers, Ghent 09.2007 chairman, representative Board
Prof.Dr. R. Steininger, Vienna 11.2004 representative Austria
Dr. O. Detry, Liège 01.2000 representative Belgium
Prof.Dr. P. Michielsen, Antwerp 01.2008 representative Belgium
Prof.Dr. P. Neuhaus, Berlin 09.1994 representative Germany
Prof.Dr.N. Senninger, Münster 01.2004 representative Germany
Prof.Dr. G. Otto, Mainz 01.2008 representative Germany
Prof.Dr. R. Porte, Groningen 01.2006 representative the Netherlands
Dr. V. Sojar, Ljubljana 01.2008 representative Slovenia
Dr. B. Kocman, Zagreb 04.2008 representative Croatia
Dr. A. Rahmel, Eurotransplant 02.2007 secretary a.i.
PANCREAS ADVISORY COMMITTEE (EPAC)
Name As of Remarks
Prof.Dr. W. Schareck, Rostock 12.2005 chairman, representative Board
Prof.Dr. P. Hengster, Innsbruck 11.2004 representative Austria
Prof.Dr. C. Mathieu, Leuven 02.2006 representative Belgium
Dr. H. Arbogast, Munich 03.2009 representative Germany
Prof.Dr. R. Viebahn, Bochum 11.2004 representative Germany
Dr. A. Kahl, Berlin 01.2006 representative Germany
Dr. J. Ringers, Leiden 04.1998 representative the Netherlands
Dr. A. Tomazič, Ljubljana 01.2007 representative Slovenia
Dr. S. Jadrijević, Zagreb 04.2008 representative Croatia
Prof.Dr. F.H.J. Claas, Leiden (ETRL) 08.1994 representative TT Assembly
Dr. K. Kovac, Eurotransplant 10.2009 secretary
THORACIC ADVISORY COMMITTEE (EThAC)
Name As of Remarks
Prof.Dr. G. Laufer, Vienna 10.2001 chairman, representative Board
Prof.Dr. A. Wasler, Graz 11.2001 representative Austria
Prof.Dr. A. Zuckermann, Vienna 01.2008 representative Austria
Prof.Dr. P. Evrard, Brussels (LA) 01.2004 representative Belgium
Prof.Dr. M. Depauw, Ghent 01.2006 representative Belgium
Dr. P. Überfuhr, Munich 02.2006 representative Germany
Dr. U. Schulz, Bad Oeynhausen 05.2006 representative Germany
Prof.Dr. H. Reichenspurner, Hamburg 02.2008 representative Germany
Dr. H. Bittner, Leipzig 02.2008 representative Germany
Dr. W. van der Bij, Groningen 06.2001 representative the Netherlands
Dr. N. de Jonge, Utrecht 01.2004 representative the Netherlands
Prof.Dr. I. Kneževič, Ljubljana 07.2007 representative Slovenia
Prof.Dr. Z. Sutlić, Zagreb 04.2008 representative Croatia
Dr. J. Smits, Eurotransplant 07.2002 secretary
ORGAN PROCUREMENT COMMITTEE (OPC)
Name As of Remarks
Prof.Dr. D. Ysebaert, Antwerp 10.2005 chairman, representative Board
Prof.Dr. G. Berlakovich, Vienna 11.2009 representative TC’s Austria
Ms. G. Van Beeumen, Antwerp 02.2006 representative TC’s Belgium
Dr. N. Frühauf, Hanover 01.2008 representative DSO Germany
Prof.Dr. E. Klar, Rostock 01.2008 representative TC’s Germany
Ms. J. Hagenaars, Rotterdam 04.2008 representative TC’s NL
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24. Dr. B. Trotovšek, Ljubljana 01.2008 representative Slovenia
Dr. Z. Zupan, Rijeka 04.2008 representative Croatia
Prof.Dr. F. Mühlbacher, Vienna 11.2009 representative ETKAC
Dr. O. Detry, Liège 01.2000 representative ELIAC
Dr. J. Ringers, Leiden 04.2002 representative EPAC
Prof.Dr. A. Zuckermann, Vienna 04.2008 representative EThAC
Prof.Dr. I. Doxiadis, Leiden (ETRL) 02.1998 representative TTAC
Dr. I. Tieken, Eurotransplant 09.2007 secretary
COMPUTER SERVICES WORKING GROUP (CSWG)
Name As of Remarks
Prof.Dr. F. Mühlbacher, Vienna 09.1995 chairman, representative Board + ETKAC
Dr. R. Kramar, Wels 09.1995 representative Austria
Mr.W. Van Donink, Antwerp 10.2009 representative Belgium
Dr. M. Schenk, Tübingen 01.2008 representative Germany
Dr. A. Hoitsma, Nijmegen 09.1995 representative the Netherlands
Mr. T. Campelj, Ljubljana 01.2006 representative Slovenia
Vacancy representative ELIAC
Dr. W. van der Bij, Groningen 05.2002 representative EThAC
Dr. S. Lems, Groningen 06.1996 representative TTAC
Drs. T. Valkering, Eurotransplant 05.2008 secretary
TISSUE TYPING ADVISORY COMMITTEE (TTAC)
Name As of Remarks
Prof.Dr. F.H.J. Claas, Leiden (ETRL) 09.1995 chairman, representative Board
Prof.Dr.W. Mayr, Vienna 01.2008 representative Austria
Prof.Dr. M.-P. Emonds, Leuven 02.2006 representative Belgium
Dr. F. Hentges, Luxembourg 09.1995 representative Luxembourg
Dr. C. Schönemann, Berlin 11.2002 representative Germany
Dr. J. Mytilineos, Ulm 01.2006 representative Germany
Dr. S. Lems, Groningen 09.1995 representative the Netherlands
Dr. B. Vidan Jeras, Ljubljana 12.1999 representative Slovenia
Prof.Dr. R. Zunec, Zagreb 04.2008 representative Croatia
Prof.Dr. I.I.N. Doxiadis, Leiden (ETRL) 09.1995 secretary
ETHICS COMMITTEE (ETEC)
Name As of Remarks
Prof.Dr. P. Schotsmans, Leuven 01.2001 chairman, representative Board
Drs. M. Bos, The Hague 05.1995 vice-chairman, representative the Netherlands
Prof.Dr. W. Schaupp, Vienna 04.1998 representative Austria
Prof.Dr. I. Kerremans, Ghent 03.2004 representative Belgium
Prof.Dr. R. Viebahn, Bochum 11.2006 representative Germany
Dr. D. Rigler Pleterski, Ljubljana 01.2000 representative Slovenia
Dr. J. Stoić Brezak, Zagreb 04.2008 representative Croatia
Dr. A. Rahmel, Eurotransplant 12.2006 secretary a.i.
FINANCIAL COMMITTEE (FC)
Name As of Remarks
Prof.Dr. A.P.W.P. van Montfort, Utrecht 05.2003 chairman, representative Board
Mag. O. Postl, Vienna 05.1995 representative Austria
Prof.Dr. D. Ysebaert, Antwerp 05.1995 representative Belgium
Prof.Dr. B. Reichart, Munich 03.2009 representative Germany
Ms. M. Konda, Ljubljana 01.2006 representative Slovenia
Drs. T. Valkering, Eurotransplant 05.2008 secretary
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25. 1.6 recommendations approved
In 2009, the following recommendations were submitted by the Advisory Committees and approved by the Board of
Eurotransplant International Foundation:
Kidney advisory committee (etKac)
rKac01.09
If one or more consecutive kidney transplants fail requiring maintenance dialysis within 3 months after transplantation, and
the recipient is re-entered on the waiting list, waiting time will be returned starting from the dialysis time before the first
failed transplant.
rKac02.09
Children either on dialysis or registered on the ET waiting list before the age of 16, should be granted a pediatric status until
their first successful graft, irrespective of their age at the time of an offer. In case of a pre-emptive registration on the kidney
waiting list, the pediatric status will end on the 17th birthday, if dialysis is not initiated before this date.
Recipients on dialysis or registered on the waiting list after their 16th birthday will be granted the pediatric status provided
that they are proven to be in maturation. This proof has to be delivered by the transplant center by a report of a competent
radiologist or pediatric endocrinologist on an X-ray of the left hand that has to be sent to and judged on by two independent
auditors appointed by ET. In case of a split decision a third auditor has to be consulted for a final decision.
The pediatric status will be withdrawn when dialysis does not start within one year after registration, but will be restored when
the recipient fulfils above criteria for maturation at time of institution of dialysis.
The effect of these changes should be evaluated after 2 years.
rKac03.09
In case of a donor <16 years of age recipients having the pediatric status are listed directly after 000 HLA mismatched
recipients, provided that the recipient specific donor profile on maximum donor age and accepted HLA mismatches is entered
into ENIS. The ranking order among these recipients should be according to the ETKAS overall point score system.
rKac04.09
The current, age dependent, pediatric bonus should be replaced by a uniform bonus of 100 points for al recipients having the
pediatric status.
liver intestine advisory committee (eliac)
rlac01.09
Establishment of a liver transplant follow-up registry (ET Liver-FU Registry)
1. The dataset to be collected by the ET Liver-FU Registry will be defined by the ELIAC taking into account the needs of
established registries (ELTR, CTS). The ELIAC takes the function of the scientific advisory committee of this registry.
2. Liver transplant centers have to report outcome of deceased and living donor transplantation to ET at 3 months after TXP,
at one year after TXP and yearly thereafter until the death of the patient. Data have to be delivered within one month of
the due data. Non-adherence to this rule will result in informing the ELIAC. The ELIAC strongly suggests that for each
country the respective competent national authority will be informed in case of non-compliance.
3. The data delivered to ET Liver-FU Registry will be handled confidentially. As defined in the general ET-data analysis and
delivery rules, patient- and center-specific data will only be delivered to the respective transplant center, unless consent
is given by the individual patients/centers.
4. ET will offer the option of transfer of the necessary datasets to other registries (e.g. ELTR, CTS). Data exchange with
another registry will only take place on explicit request of a transplant center.
5. Studies involving data delivered to ET Liver-FU Registry will be published in the name of the ET liver transplant
community. They will require the approval of the ELIAC before publication. Strict rules regarding authorship will be
established.
rlac03.09
In case for a patient an ACO status for combined transplantation is granted according to the established ACO rules and the
patient in addition receives the HU status according to the organ specific criteria for one of the organs for which the ACO
status is granted, the patient will be listed in HU status for all the organs he/she is waiting for.
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26. In case of a pediatric patient (recipient at time of listing below the age of 12) the initial match MELD shall reflect an expected
3-month mortality of 35%. The matchMELD shall then be increased 3-monthly according to an increase in expected mortality
on the waiting list by 15%.
pancreas advisory committee (epac)
rpac01.09
The EPAC recommends abandoning granting (international) SU-status for pancreas islet retransplantation.
rpac02.09
Any pancreas, independent of donor age and BMI, should first be offered to ACO (Approved Combined Organ) and SU status
recipients.
thoracic advisory committee (ethac)
rthac02.07 rephrased
Upon the request for upgrading of an urgency status for heart and/or lung transplant candidates auditors need to provide an
answer to the ET allocation office within 6 hours after the request has been sent. In case auditors have additional questions
related to the request, these will be forwarded to the requesting center by ET and the requesting center has to answer within
6 hours after these questions were received. In case the requesting center does not agree with the auditors’ decision, the
requesting center has maximal one opportunity of putting forward its objection. The auditors’ decision in the second round
is the final decision.
rthac01.09
• All patients needing a cross-match must be reported to ET.
• Of all patients needing a cross-match, serum must be sent around to the ET HLA labs responsible for the initial donor
cross-match.
• It is the responsibility of the transplant centers to ensure that the most recent serum is sent around.
• If a sensitized patient is selected in the match and serum for a cross-match is not available in the donor region then no
organ offer will be made or the conditional offer will be withdrawn.
• The center that has the reserve offer as well as the center with the primary offer should accept that the other center
retrieves the organ. Both teams should decide who is to retrieve the organ. (In case of conflict the center with the primary
offer has priority).
rthac02.09
The EThAC recommends using the ET Code of Conduct for Thoracic Auditors as a leading document for addressing HU
requests.
organ procurement committee (opc)
ropc03.08*
Recommendation performing pathology research in case of tumor:
In case a tumor is found, it is strongly recommended to perform a pathology research to have a clear diagnosis on this
tumor.
ropc04.08*
a. If a procured organ can not be transplanted, it is mandatory to contact ET directly and only with approval of ET this organ
can be discarded.
b. Discarding an organ is only possible in four ways:
1. Leave the organ with the donor;
2. Send the organ for destruction, a confirmation report is needed;
3. Use for research in case of consent;
4. Allocation is changed towards donation of cells or tissues in case of consent.
c. The confirmation report of destruction should be forwarded to ET. ET is responsible for the documentation of these
reports of discarded organs.
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27. tissue typing advisory committee (ttac)
rttac01.09
In case the HLA-typing is available prior to the start of allocation, a kidney match has to be performed first. If there is a
recipient on the AM-mismatch kidney transplant waiting list, who is in need of a combined transplantation, the kidney and
non-renal organ(s) will be offered to this recipient first, independent of the non-renal organ ranking.
Financial committee (Fc)
rFc04.08*
The Financial Committee recommends adopting the new model of budget proposal (8037FC08).
rFc01.09
The Financial Committee recommends the Board to approve the final budget proposal 2009.
rFc02.09
The Financial Committee recommends the Board to approve the annual accounts 2008.
rFc03.09
The Financial Committee recommends the Board to approve the budget proposal 2010.
*Submitted by the end of 2008, but accepted by the beginning of 2009.
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28. 2. Basic principles of the
Eurotransplant community
This chapter gives some general information on the ET mission, on the services we provide and on the relationship with
our member states. The Eurotransplant International Foundation is responsible for the mediation and allocation of organ
donation procedures in Austria, Belgium, Croatia, Germany, Luxembourg, the Netherlands and Slovenia. In this international
collaborative framework, the participants include all transplant hospitals, tissue typing laboratories and hospitals where organ
donations take place. The ET region numbers well over 124.5 million.
In the following paragraphs the following topics are covered:
1. ET’s mission, aims and goals;
2. The basic services that ET provides to its member states as laid down in ET’s Basic Mandate;
3. Formal support to ET by the ministries of Health of ET’s member states: the so-called ‘Joint Declaration’.
2.1 eurotransplant mission statement
Mission
Eurotransplant is a service organization for transplant candidates through the collaborating transplant programs within the
organization.
Eurotransplant Aims
Eurotransplant is an international, non-profit exchange organization whose aim is to encourage organ transplantation. It
encourages the international exchange of donor organs across a region with 124.5 million inhabitants. Eurotransplant provides
services to transplant centers and their associated tissue typing laboratories and donor hospitals in Austria, Belgium, Croatia,
Germany, Luxembourg, the Netherlands and Slovenia.
Goals
• To achieve an optimal use of available donor organs and tissues.
• To secure a transparent and objective selection system, based upon medical criteria.
• To assess the importance of factors which have the greatest influence on waiting list mortality and transplant results.
• To support donor procurement to increase the supply of donor organs and tissues.
• To further improve the results of transplantation through scientific research and to publish and present these results.
• Promotion, support and coordination of organ donation and transplantation in the broadest sense of terms.
The following document was agreed upon by all National Authorities of Eurotransplant. It describes that basic services that every
member states expects Eurotransplant to provide. The budget for Eurotransplant’s basic services is guaranteed by all National
Authorities. Specific wishes from member states are often laid down in country specific Service Level Agreements.
2.2 basic mandate of eurotransplant
The Basic Mandate of Eurotransplant includes the following elements:
1. Assignment
2. Services
3. Support
1. Assignment
The process
ET’s primary assignment is to coordinate the international exchange and allocation of donor organs. To carry out this
assignment ET performs activities related to the whole process of organ donation and transplantation. The process includes
the following responsibilities:
• Coordination of donor procedures and support of donor procurement;
• Maintaining a waiting list;
• Receiving donor offers;
• Providing central support and advice for the transplant centers, tissue typing laboratories and donor hospitals;
• International coordination of transportation;
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