Organ Donation and Transplantation in Europe:

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• Organ Donation and Transplantation in Europe
• the state of the art anno 2009

VIth Danubian Transplant Symposium
Dr. Guido G. Persijn Vienna, December 11, 2009
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- Organ Donation -
Dont take your organs to heaven, heaven knows
we need them here.
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Topics Today

• Eurotransplant
• Waiting lists
• Donation
• Transplantation
• Problems
• Future

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The longer you can look back the further you
can look forward
Winston Churchill, at the Royal College of
Physicians in London, 1944
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• 300 AD, Turkey
• The first limb transplantaccording to
  thelegend of SaintCosmas and Saint
  Damian.PatientDeacon Justinian

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• 1954, Boston USA
• First successful kidney transplant in the world
  (8 years functioning) by Joseph Murray.
  Donor-recipient Identical twins (Richard and
  Ronald Herrick).

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Blood transfusion (1954)
Pregnancy (1958)
Jean Dausset Jon van
Rood Rose Payne
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HLA matching enhances skin graft survival
.start Eurotransplant
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Graft survival renal transplants in
Eurotransplantmatched on basis of 9
agglutination groups (1967-1972)
years after transplantation
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1967
- Human Leucocyte antigens -
A proposal for international cooperation in organ
transplantation EUROTRANSPLANT
Prof. Dr. J.J. van Rood
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Leiden
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12 European OEOs, geographically
Scandiatransplant UK Transplant ADLB,
France Swiss Transplant Lusotransplante ONT,
Spain
Eurotransplant Poltransplant Czechtransplant Hu
ngarotransplant CNT, Italy HNTO, Greece
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Eurotransplant Mission Statement
ET is a service organization for all the
transplant centers and tissue typing laboratories
within the ET region
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Goals of Eurotransplant

• Optimal use of available donor organs
• Secure a transparent and objective allocation
  system

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ET involvement
In SinceKidneys 1967 Corneas 1976 Livers 1979
Pancreas 1980 Hearts 1982 Heart /
Lung 1984 Lungs 1987 Intestines 1997
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Austria Belgium Netherlands Germany
Luxemburg Slovenia Croatia
Population 124 million
EUROTRANSPLANT
Transplant centers
Renal66
Heart39
Pancreas38
Intestine6
Lung25
Liver37
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Topics Today

• Eurotransplant
• Waiting lists
• Donation
• Transplantation
• Problems
• Future

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Renal patients in Eurotransplant
10687
3376
2008
incl. kidney pancreas
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Patients on the active waiting list of
Eurotransplant
2354
989
846
300
57
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Topics Today

• Eurotransplant
• Waiting lists
• Donation
• Transplantation
• Problems
• Future

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Donors reported and used in Eurotransplant
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Organ donation in Eurotransplant 2008
PMP
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Post-mortem donation per million populationET
1992 - 2008
24,9
20,2
15,6
14,4
12,3
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Number of post-mortem donors p.m.p. 2008
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Number of non-heart beating donors p.m.p. 2008
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Topics Today

• Eurotransplant
• Waiting lists
• Donation
• Transplantation
• Problems
• Future

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Dynamics of the Eurotransplant kidney waiting
list and transplants
10687
3376
1077
2008
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Number of post-mortem kidney transplants p.m.p.
2008

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Liver transplants in Eurotransplant
2354
1600
2008
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Number of post-mortem liver transplants p.m.p.
2008
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Heart transplants in Eurotransplant
989
582
2008
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Number of heart transplants p.m.p. 2008
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Number of lung transplants p.m.p. 2008
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Number of post-mortem kidney pancreas
transplants p.m.p. 2008
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Topics Today

• Eurotransplant
• Waiting lists
• Donation
• Transplantation
• Problems
• Future

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How do we solve the ever lasting problems of
organ shortage?
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Ways to increase organ supply

• Legislation e.g. presumed consent
• Living donation (related, unrelated, x-over)
• Cadaveric donation (NHBD, marginal donors)
• Alternatives
• Xenotransplantation (still future!)
• Cloning of organs from human stem cells
• Artificial organs

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Gesetzgebung Europa / Eurotransplant
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Living (un)related kidney transplantation in
Eurotransplant
Nr. of transplants
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Number of living kidney transplants p.m.p. 2008
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Number of living liver transplants p.m.p. 2008
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Cross-Over Kidney Transplantation
Program in the Netherlands - January 1, 2004 -
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Background
Direct living donation not possible, because of
D R

• Bloodgroup incompatibility

• Positive cross-match

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The solution Cross-over
D R
D R
Pair A
Pair B
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Results2004 - 2009
312 couples 169 blood group incompatible 143
positive crossmatch
Transplanted
x-over p.m. donor other living Altruistic Tot
al
132 24 31 15 202
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Topics Today

• Eurotransplant
• Waiting lists
• Donation
• Transplantation
• Problems
• Future

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• 1964, South America
• Worlds first hand transplant performedhowever
• 1998, Lyon, France
• Second hand successfully transplanted for 3 years
  (non-compliance of the recipient).

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• 2000, Lyon, France Innsbruck, Austria
• Successful double hand transplants reported.

R. Margreiter
J.M. Dubernard
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Face transplantation
Amiens, November 27, 2005
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Double arm transplantation
Munich University Clinic, GermanyJuly 25-26,
2008
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QuestionXenotransplantation?
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• Xenotransplantation has a great future
• and always will

Norman Shumway
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The brain is the limit
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Looking for the Future

• The most important task for the community is to
  increase the number of post-mortem donor organs.
• The more organs, the greater the chance for a
  better quality of life for many, many patients.

- The future is yours -
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• Multumesc
• Thank you
• Vielen Dank
• Merci Beaucoup
• Paracalo
• Molto Grazie
• Muchas Gracias
• Domo Arrigato
• Köszönöm Szépen
• Najlepsa Hvala
• Dank U

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• For more info
• www.eurotransplant.org