Allocation of organs, particularly kidneys, within Eurotransplant

Allocation of scarce donor organs is an important discussion topic among ethical, medical, and legal experts, the public at large, and politicians. Since 1996, a new kidney allocation system based on primarily medical and patient-oriented criteria was introduced in Eurotransplant (ET). This point-scoring system takes the following factors into account: HLA-A,B,DR mismatch, mismatch probability, waiting period, i.e., time on dialysis, distance between donor/transplantation center, and balance between import/export of the six participating countries. Extra points are given to high urgency patients and to children. During the first 9 years of the new ET kidney allocation system (ETKAS) almost 30,000 deceased donor kidneys have been allocated of which 22.3% have been transplanted without HLA-A,B,DR mismatches. Twice as many long-waiting patients, i.e., >5 years, have been transplanted as compared with the pre-ETKAS period. Also substantially more children and highly sensitized patients received kidney transplants. Importantly, the balances between import and export of donor kidneys among the different ET countries remained among very well-accepted levels. Finally, overall kidney transplant survival was 78% after 3 years and a significant HLA-matching effect was noticed, i.e., 83% at 3 years for the HLA-A,B,DR mismatched combinations. In conclusion, the new ETKAS has reached its aims and goals. The main problem remains, however, the continuing shortage of deceased donor kidneys.