Ar 2009 eurotranspolant

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Ar 2009 eurotranspolant

  1. 1. 2009
  2. 2. 2009Edited byArie Oosterlee and Axel Rahmel electronic,
  3. 3. 2009 “The PerfecT MaTch” LegaLLy founded: May 12, 1969 ISo certified 9001:2008Edited byArie Oosterlee and Axel RahmelCIP-GEGEVENS KONINKLIJKE BIBLIOTHEEK, DEN HAAGAnnual Report/Eurotransplant International Foundation.–Leiden:Eurotransplant Foundation. -III., graf., tab.Published annuallyAnnual report 2009 / ed. by Arie Oosterlee and Axel RahmelISBN-13: 978-90-71658-29-7Keyword: Eurotransplant Foundation; annual reports.2 electronic,
  4. 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 151. rEporT of ThE Board and ThE cEnTral offIcE of 16 sTIchTIng EuroTransplanT InTErnaTIonal foundaTIon1.1 Report of the Eurotransplant Board 161.2 Report of the Eurotransplant office 181.3 Future policy 201.4 Quality Assurance & Safety 201.5 Advisory Committees 211.6 Recommendations approved 242. BasIc prIncIplEs of ThE EuroTransplanT communITy 272.1 Eurotransplant mission statement 272.2 Basic Mandate of Eurotransplant 272.3 Joint Declaration on cooperation within the framework of Eurotransplant International Foundation 303. EuroTransplanT: donaTIon, waITIng lIsTs and TransplanTs 32- Introduction 32Table 3.1 Number of deceased organ donors used for a transplant, by donor country, from 2005 to 2009 33Figure 3.1 Median age of deceased donors in Eurotransplant, used for a transplant 33Table 3.2(i) Number of deceased organ donors used for a transplant, by organ, from 2005 to 2009 33Table 3.2(ii) Number of deceased organ donors used for a transplant, by organ and donor country, in 2009 33Table 3.3(i) Demographic data on deceased organ donors, used for a transplant, from 2005 to 2009 34Table 3.3(ii) Demographic data on deceased organ donors, used for a transplant, in 2009 34Table 3.4a(i) Number of donors, used for a transplant, by type of donor, from 2005 to 2009 35Table 3.4a(ii) Number of donors, used for a transplant, by type and donor country, in 2009 35Table 3.4b(i) Number of deceased donors, used for a transplant, by type of donor, from 2005 to 2009 35Table 3.4b(ii) Number of deceased donors, used for a transplant, by type and donor country, in 2009 35Table 3.4c(i) Non-heart beating (NHB) donors, used for a transplant, from 2005 to 2009 35Table 3.4c(ii) Non-heart beating donors, used for a transplant, by donor country, in 2009 36Table 3.4d(i) Transplants from NHB donors, from 2005 to 2009 36Table 3.4d(ii) Transplants from NHB donors, by donor country, in 2009 36Table 3.5(i) Active Eurotransplant waiting list, by organ, as per December 31, from 2005 to 2009 36Table 3.5(ii) Active Eurotransplant waiting list, by organ, as per December 31, 2009 37Table 3.6(i) Registration events on the Eurotransplant waiting list, by organ, from 2005 to 2009 38Table 3.6(ii) Registration events on the Eurotransplant waiting list, by organ and country, in 2009 38Table 3.7(i) Number of transplanted organs**, by organ, by donor type, from* 2005 to 2009 39 3
  5. 5. Table 3.7(ii) Number of transplanted organs**, by organ, by donor type, by country of transplant, in* 2009 39Table 3.8(i) Transplants from 2005 to 2009 39Table 3.8(ii) Transplants in 2009, by transplant country 40Table 3.9(i) Mortality on the Eurotransplant waiting list, by date of death, from 2005 to 2009 40Table 3.9(ii) Mortality on the Eurotransplant waiting list in 2009, by country 41Figure 3.2 Median age of patients on active waiting list 41Figure 3.3 Median age of transplant recipients (deceased donor transplants) 41Figure 3.4 Median waiting time for patients on active waiting list at year end 42Figure 3.5 Median waiting time to transplant (deceased donor transplants) 424. KIdnEy: donaTIon, waITIng lIsTs and TransplanTs 43Table 4.1(i) Deceased donors / kidneys in Eurotransplant, from 2005 to 2009 43Table 4.1(ii) Deceased donors / kidneys in Eurotransplant in 2009 43Figure 4.1 Kidney waiting list, number of patients at year end, by urgency 44Figure 4.2 Kidney waiting list, percentage of patients at year end, by urgency 44Table 4.2(i) Active kidney transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 44Table 4.2(ii) Active kidney transplant waiting list, as per December 31 , 2009 - characteristics 45Table 4.3(i) Active kidney-only transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 45Table 4.3(ii) Active kidney-only transplant waiting list, as per December 31, 2009 - characteristics 45Figure 4.3 Number of deceased donor kidney transplants, by recipient urgency at transplant 46Figure 4.4 Percentage of deceased donor kidney transplants, by recipient urgency at transplant 47Table 4.4(i) Kidney transplant characteristics from 2005 to 2009 47Table 4.4(ii) Kidney transplant characteristics - 2009 48Table 4.5(i) Living donor kidney transplants - kidney-only from 2005 to 2009 49Table 4.5(ii) Living donor kidney transplants - kidney-only - 2009 50Figure 4.5 Dynamics of the Eurotransplant kidney transplant waiting list and transplants between 1969 and 2009 505. ThoracIc organs: donaTIon, waITIng lIsTs and TransplanTs 51Table 5.1(i) Deceased donors / hearts in Eurotransplant from 2005 to 2009 51Table 5.1(ii) Deceased donors / hearts in Eurotransplant in 2009 51Table 5.2(i) Deceased donors / lungs in Eurotransplant from 2005 to 2009 51Table 5.2(ii) Deceased donors / lungs in Eurotransplant in 2009 52Figure 5.1 Heart waiting list, number of patients at year end, by urgency 52Figure 5.2 Heart waiting list, percentage of patients at year end, by urgency 53Table 5.3(i) Active heart transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 53Table 5.3(ii) Active heart transplant waiting list as per December 31, 2009 - characteristics 53Table 5.4(i) Active heart-only transplant waiting list as per December 31 - characteristics 53Table 5.4(ii) Active-heart only transplant waiting list as per December 31, 2009 - characteristics 54Table 5.5(i) Active heart + lung transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 54Table 5.5(ii) Active heart + lung transplant waiting list, as per December 31, 2009 - characteristics 55Table 5.6(i) Active heart + lung transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 55Table 5.6(ii) Active heart + lung transplant waiting list as per December 31, 2009 - characteristics 55Figure 5.3 Lung waiting list, number of patients at year end, by urgency 56Figure 5.4 Lung waiting list, percentage of patients at year end, by urgency 56Table 5.7(i) Active lung transplant waiting list as per December 31, from 2005 to 2009 - characteristics 57Table 5.7(ii) Active lung transplant waiting list as per December 31, 2009 - characteristics 57Table 5.8(i) Active lung-only transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 57Table 5.8(ii) Active lung-only transplant waiting list, as per December 31, 2009 - characteristics 57Figure 5.5 Number of deceased donor heart transplants, by recipient urgency at transplant 58Figure 5.6 Percentage of deceased donor heart transplants, by recipient urgency at transplant 59Table 5.9(i) Heart transplants from 2005 to 2009 - characteristics 59Table 5.9(ii) Heart transplants 2009 - characteristics 60Table 5.10(i) Heart + lung transplants from 2005 to 2009 - characteristics 60Table 5.10(ii) Heart + lungs transplants 2009 - characteristics 61Figure 5.7 Number of deceased donor lung transplants, by recipient urgency at transplant 62Figure 5.8 Percentage of deceased donor lung transplants, by recipient urgency at transplant 62Table 5.11(i) Lung transplants from 2005 to 2009 - characteristics 62Table 5.11(ii) Lung transplants 2009 - characteristics 634
  6. 6. Figure 5.9 Dynamics of the Eurotransplant heart waiting list and transplants between 1991 and 2009 64Figure 5.10 Dynamics of the Eurotransplant heart + lung waiting list, heart + lung transplants, lung waiting list and 64 lung transplants, between 1991 and 20096. lIvEr and InTEsTInE: donaTIon, waITIng lIsTs and TranplanTs 65Table 6.1(i) Deceased donors / livers in Eurotransplant from 2005 to 2009 65Table 6.1(ii) Deceased donors / livers in Eurotransplant in 2009 65Figure 6.1 Liver waiting list, number of patients at year end, by urgency 66Figure 6.2 Liver waiting list, percentage of patients at year end, by urgency 66Table 6.2(i) Active liver transplant waiting list, as per December 31, from 2005 to 2009 - characteristics 67Table 6.2(ii) Active liver transplant waiting list, as per December 31, 2009 - characteristics 67Table 6.3(i) Active liver-only transplant waiting list as per December 31, from 2005 to 2009 - characteristics 67Table 6.3(ii) Active liver-only transplant waiting list as per December 31, 2009 - characteristics 68Figure 6.3 Number of deceased donor liver transplants, by recipient urgency at transplant 68Figure 6.4 Percentage of deceased donor liver transplants, by recipient urgency at transplant 69Table 6.4(i) Liver transplants from 2005 to 2009 - characteristics 69Table 6.4(ii) Liver transplants 2009 - characteristics 70Table 6.5(i) Living donor liver transplants - liver-only - from 2005 to 2009 70Table 6.5(ii) Living donor liver transplants - liver-only - 2009 71Figure 6.5 Dynamics of the Eurotransplant liver waiting list and liver transplants between 1991 and 2009 72- Intestine transplants 2009 73Table 6.6 Number of intestinal transplants in 2009 737. pancrEas and IslETs: donaTIon,waITIng lIsTs and TransplanTs 74Table 7.1(i) Deceased donors / pancreas in Eurotransplant from 2005 to 2009 74Table 7.1(ii) Deceased donors / pancreas in Eurotransplant in 2009 74Figure 7.1 Pancreas waiting list, number of patients at year end, by urgency 75Figure 7.2 Pancreas waiting list, percentage of patients at year end, by urgency 75Table 7.2(i) Active pancreas transplant waiting list as per December 31, from 2005 to 2009 - characteristics 75Table 7.2(ii) Active pancreas transplant waiting list as per December 31, 2009 - characteristics 76Table 7.3a(i) Active pancreas-only transplant waiting list as per December 31, from 2005 to 2009 - characteristics 76Table 7.3a(ii) Active pancreas-only transplant waiting list as per December 31, 2009 - characteristics 76Table 7.3b(i) Active kidney + pancreas transplant waiting list as per December 31, from 2005 to 2009 - characteristics 77Table 7.3b(ii) Active kidney + pancreas transplant waiting list as per December 31, 2009 - characteristics 77Figure 7.3 Number of deceased donor pancreas transplants, by recipient urgency at transplant 78Figure 7.4 Percentage of deceased donor pancreas, by recipient urgency at transplant 79Table 7.4a(i) Pancreas transplants 2005 to 2009 - characteristics 79Table 7.4a(ii) Pancreas transplants 2009 - characteristics 80Table 7.4b(i) Pancreas islet transplants, from 2005 to 2009 80Table 7.4b(ii) Pancreas islet transplants in 2009 80Table 7.4c(i) Pancreas transplants from 2005 to 2009 - characteristics 81Table 7.4c(ii) Pancreas transplants 2009 - characteristics 81Figure 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 20098. hIsTocompaTIBIlITy TEsTIng 838.1 Introduction 838.2 Eurotransplant External Proficiency Testing Schemes 838.2.1 External Proficiency Testing on HLA typing 838.2.2 External Proficiency Testing on cross matching 83Table 8.1 Report of the crossmatch results (DTT = dithiothreitol). 848.2.3 External Proficiency Testing Exercise on screening 84Table 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 84Table 8.3 Evolution of the Acceptable Mismatch Program 858.4 Other activities 85 5
  7. 7. 9. scIEnTIfIc ouTpuT In 2009 86- Publications - Articles / Abstracts 86- Invited Lectures 88- Chairmenships 89- Oral Presentations 90- Poster Presentations 9110. EuroTransplanT pErsonnEl rElaTEd sTaTIsTIcs 9211. 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 966
  8. 8. Board of EurotransplantInternational foundationas per December 31, 2009Prof.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 sections6 members B: members representing national transplant societies1 member C: head of the Eurotransplant Reference Laboratory2 members D: one member being financial expert, one member representing society (ethicist) 7
  9. 9. transplant programs anD their Delegates in 2009Definitions (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 DelegateAustriaGA Medizinische Universitätsklinik, Graz S. HornIB Chirurgische Universitätsklinik, Innsbruck C. BösmüllerOE Krankenhaus der Elisabethinen, LinzOL Allgemeines Krankenhaus, Linz E. PohankaWG Universitätsklinik für Chirurgie, Wien F. MühlbacherBelgiumAN Universitair Ziekenhuis Antwerpen, Edegem D. YsebaertBJ Universitair Ziekenhuis Brussel, Campus Jette J. SennesaelBR ULB, Hôpital Erasme, Bruxelles D. AbramowiczGE Universitair Ziekenhuis, Gent P. PeetersLA Cliniques Universitaires St. Luc, Bruxelles M. MouradLE Kinderdialyse Universitair Ziekenhuis Gasthuisberg, Leuven R. Van Damme-LombaertsLG Centre Hospitalier Universitaire, LiègeLM Universitair Ziekenhuis Gasthuisberg, Leuven Y. VanrenterghemGermanyAK Universitätsklinikum der Rheinisch-Westfälischen TH, Aachen A. HomburgAU Zentralklinikum, Augsburg H. WeihprechtBB Ruhr Universität, Bochum P. SchenkerBC Charité-Campus Virchow Klinikum der Humboldt Universität, BerlinBE Universitätsklinikum Benjamin Franklin, Berlin M. van der GietBM Kliniken der Freien Hansestadt, Bremen F. ZantvoortBO Klinikum der Urologischen und Medizinischen Universität, Bonn R. WoitasDR Technischen Universität, Dresden S. LeikeDU Med. Einrichtungen der Heinrich-Heine-Universität, Düsseldorf K. IvensER/NB Med. Einrichtungen der Universität Erlangen-Nürnberg, Erlangen K. PressmarES Universitätsklinikum, Essen O. WitzkeFD Klinikum Fulda, FuldaFM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt E. ScheuermannFR Klinikum der Albert-Ludwigs-Universität, Freiburg P. PisarskiGI Klinikum der Justus-Liebig-Universität, Gießen F. RennerGO Klinikum der Georg-August-Universität, Göttingen A. ObedHA Klinikum der Martin-Luther-Universität, Halle A. HamzaHB Klinikum der Ruprecht-Karls-Universität, Heidelberg C. MorathHG Universitäts-Krankenhaus Eppendorf, Hamburg F. ThaissHM Nephrologisches Zentrum Niedersachsen, Hann. Münden V. KliemHO Klinikum der Medizinischen Hochschule, Hannover F. LehnerHS Klinikum der Universität des Saarlandes, Homburg/Saar U. SesterJE Klinikum der Friedrich-Schiller-Universität, Jena U. Ott8
  10. 10. KI Klinikum Christian-Albrechts-Universität, Kiel F. BraunKL Klinik der Universität Köln-Lindenthal, Köln W. ArnsKM Kliniken der Stadt Köln gGmbH, Krankenhaus Merheim, Köln-Merheim, Köln W. ArnsKK Klinik und Poliklinik für Kinderheilkunde der Universität Köln-Lindenthal, Köln W. ArnsKS Westpfalz-Klinikum, Kaiserslautern Th. RathLP Klinikum der Universität, Leipzig M. BartelsLU Klinikum der Medizinischen Universität, Lübeck M. NitschkeMA Klinikum der Stadt, Mannheim P. SchnülleMH Klinikum Rechts der Isar der Technischen Universität, München U. HeemannML Klinikum Großhadern der Ludwig-Maximilians-Universität, München K.-W. JauchMN Klinikum der Westfälischen Wilhelms-Universität, Münster H. WoltersMR Klinikum Lahnberge der Philipps-Universität, Marburg J. HoyerMZ Klinikum der Johannes-Gutenberg-Universität, Mainz O. SchreinerRB Klinikum der Universität, Regensburg B. BanasRO Klinikum der Universität, Rostock O. HakenbergST Katharinenhospital, Stuttgart J. WilhelmTU Klinikum der Eberhard-Karls-Universität, Tübingen S. NadalinUL Klinikum der Universität, Ulm M. WittauWZ Klinikum der Julius-Maximilians-Universität, Würzburg K. LopauLuxembourgLX Centre Hospitalier de Luxembourg P. DuhouxThe NetherlandsAV VU Medisch Centrum, Amsterdam S. NurmohamedAW Academisch Medisch Centrum, Amsterdam F. BemelmanGR Academisch Ziekenhuis, Groningen J. Homan van der HeideLB Leids Universitair Medisch Centrum, Leiden J. de FijterMS Academisch Ziekenhuis, Maastricht M. ChristiaansNY Universitair Medisch Centrum St. Radboud, Nijmegen A. HoitsmaRD Erasmus Medisch Centrum, Rotterdam W. WeimarRS Sophia Kinderziekenhuis, Rotterdam K. CransbergUT Universitair Medisch Centrum, Utrecht A. van ZuilenUW Wilhelmina Kinderziekenhuis, Utrecht M. LilienSloveniaLO University Medical Center, Ljubljana D. KovačCroatiaOS University Hospital, Osijek J. GalićRI University Clinical Hospital, Rijeka L. OrlićZA University Clinical Cospital, Zagreb J. PasiniZM Clinical Hospital Zagreb Merkur, Zagreb M. Knotekheart programs DelegateAustriaGA Chirurgische Universitätsklinik, Graz A. WaslerIB Chirurgische Universitätsklinik, Innsbruck L. MüllerWG Universitätsklinik für Chirurgie, Wien A. ZuckermannBelgiumAN Universitair Ziekenhuis Antwerpen, Edegem I. RodrigusAS Onze Lieve Vrouw Ziekenhuis, Aalst I. DeblierBR Université Libre de Bruxelles, Hôpital Erasme, Bruxelles M. AntoineGE Universitair Ziekenhuis, Gent F. CaesLA Cliniques Universitaires St. Luc, Bruxelles A. PonceletLG Centre Hospitalier Universitaire, Liège J. DefraigneLM Universitair Ziekenhuis Gasthuisberg, Leuven J. Vanhaecke 9
  11. 11. GermanyAK Universitätsklinikum der Rheinisch-Westfälischen TH, Aachen A. MozaBA Herz- & Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen U. SchulzBD Deutsches Herzzentrum, BerlinBH Kerckhoff Klinik, Bad Nauheim M. RichterDR Universitätsklinikum Carl Gustav Carus, Dresden S. BroseER/NB Med. Einrichtungen der Universität Erlangen-Nürnberg, Erlangen R. TandlerES Universitätsklinikum, Essen M. KamlerFM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt M. SchererFR Klinikum der Albert-Ludwigs-Universität, Freiburg F. BeyersdorfGI Klinikum der Justus-Liebig-Universität, Gießen J. BauerGO Klinikum der Georg-August-Universität, GöttingenHB Klinikum der Ruprecht-Karls-Universität, HeidelbergHG Universitäts-Krankenhaus Eppendorf, Hamburg F. WagnerHO Klinikum der Medizinischen Hochschule, Hannover A. SimonHS Klinikum der Universität des Saarlandes, Homburg/Saar F. LangerJE Klinikum der Friedrich-Schiller-Universität, Jena A. LichtenbergKI Klinikum der Christian-Albrechts-Universität, Kiel A. ReineckeKL Klinik der Universität Köln-Lindenthal, Köln Th. WittwerLP Klinikum der Universität, Leipzig M. BartenMD Deutsches Herzzentrum, MünchenML Klinikum Großhadern der Ludwig-Maximilians-Universität, München B. MeiserMN Klinikum der Westfälischen Wilhelms-Universität, Münster S. KlotzMZ Klinikum der Johannes-Gutenberg-Universität, Mainz U. MehlhornRB Klinikum der Universität, Regensburg S. HirtWZ Universitätsklinikum, Würzburg V. LangeThe NetherlandsGR Academisch Ziekenhuis, Groningen J. BrügemannRD Erasmus Medisch Centrum, Rotterdam A. MaatUT Universitair Medisch Centrum, Utrecht N. de JongeSloveniaLO University Medical Center, Ljubljana I. KnezevićCroatiaZA University clinical hospital, Zagreb D. MilicicZD Clinical Hospital Dubrava, Zagreb Z. Sutliclung programs DelegateAustriaIB Chirurgische Universitätsklinik, Innsbruck L. MüllerWG Universitätsklinik für Chirurgie, Wien A. ZuckermannBelgiumAN Universitair Ziekenhuis Antwerpen, Edegem P. Van SchilBR ULB, Hôpital Erasme, Bruxelles M. EstenneLA Cliniques Universitaires St. Luc, Bruxelles P. EvrardLM Universitair Ziekenhuis Gasthuisberg, Leuven D. Van RaemdonckGermanyBD Deutsches Herzzentrum, BerlinDR Universitätsklinikum Carl Gustav Carus, Dresden S. BroseES Universitätsklinikum, Essen M. KamlerFR Klinikum der Albert-Ludwigs-Universität, Freiburg A. KirschbaumGI Klinikum der Justus-Liebig-Universität, Gießen R. SchulzHG Universitäts-Krankenhaus Eppendorf, Hamburg F. WagnerHO Klinikum der Medizinischen Hochschule, Hannover A. SimonHS Klinikum Universität des Saarlandes, Homburg/Saar10
  12. 12. JE Klinikum der Friedrich-Schiller-Universität, Jena M. BreuerKI Klinikum der Christian-Albrechts-Universität, KielLP Klinikum der Universität, Leizpig H. BittnerML Klinikum Großhadern der Ludwig-Maximilians-Universität, München B. MeiserMN Klinikum der Westfälischen Wilhelms-Universität, MünsterMZ Klinikum der Johannes-Gutenberg-Universität, Mainz M. DahmThe NetherlandsGR Academisch Ziekenhuis, Groningen M. ErasmusRD Erasmus Medisch Centrum, Rotterdam J. BekkersUT Universitair Medisch Centrum, Utrecht E. van de Graafliver programs DelegateAustriaGA Chirurgische Universitätsklinik, Graz F. IbererIB Chirurgische Universitätsklinik, Innsbruck W. MarkWG Universitätsklinik für Chirurgie, Wien R. SteiningerBelgiumAN Universitair Ziekenhuis Antwerpen, Edegem D. YsebaertBR ULB, Hôpital Erasme, Bruxelles V. DonckierGE Universitair Ziekenhuis, Gent X. RogiersLA Cliniques Universitaires St. Luc, Bruxelles J. LerutLG Centre Hospitalier Universitaire, Liège O. DetryLM Universitair Ziekenhuis Gasthuisberg, Leuven J. PirenneGermanyBC Charité-Campus Virchow Klinikum der Humboldt Universität, Berlin D. SeehoferBO Chirurgische Universitätsklinik, Bonn N. SpeidelER/NB Chirurgische Klinik der Universität Erlangen-Nürnberg, Erlangen V. MüllerES Universitätsklinikum, Essen A. PaulFM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt C. MönchGO Klinikum der Georg-August-Universität, Göttingen A. ObedHB Klinikum der Ruprecht-Karls-Universität, Heidelberg J. SchmidtHG Universitäts-Krankenhaus Eppendorf, Hamburg L. FischerHO Klinikum der Medizinischen Hochschule, Hannover Th. BeckerHS Klinikum Universität des Saarlandes, Homburg/Saar O. KollmarJE Friedrich Schiller Universität, Jena U. SettmacherKI Klinikum der Christian-Albrechts-Universität, Kiel F. BraunKL Klinik der Universität Köln-Lindenthal, Köln D. StippelLP Klinikum der Universität, Leipzig S. JonasMB Klinikum Otto-von-Guericke Universität, Magdeburg H. LippertMH Klinikum Rechts der Isar der Technischen Universität, München P. BüchlerML Klinikum Großhadern der Ludwig-Maximilians-Universität, München K.-W. JauchMN Klinikum der Westfälischen Wilhelms-Universität, Münster H. WoltersMZ Klinikum der Johannes-Gutenberg-Universität, Mainz M. HeiseRB Klinikum der Universität, Regensburg M. SchererTU Klinikum der Eberhard-Karls Universität, Tübingen S. NadalinThe NetherlandsGR Academisch Ziekenhuis, Groningen R. PorteLB Leids Universitair Medisch Centrum, Leiden J. RingersRD Erasmus Medisch Centrum, Rotterdam G. KazemierSloveniaLO University Medical Centre, Ljubljana S. Markovič 11
  13. 13. CroatiaZA University Clinical Hospital, ZagrebZM Clinical Hospital Merkur, Zagreb B. KocmanZP University Clinical Hospital Pediatric, Zagrebpancreas (islet) programs DelegateAustriaGA Chirurgische Universitätsklinik, Graz F. IbererIB Chirurgische Universitätsklinik, Innsbruck W. MarkWG Universitätsklinik für Chirurgie, Wien F. MühlbacherBelgiumAN Universitair Ziekenhuis Antwerpen, Edegem D. YsebaertBR ULB, Hôpital Erasme, Bruxelles A. HoangBP Academisch Ziekenhuis der Vrije Universiteit, Brussel D. PipeleersGE Universitair Ziekenhuis, Gent C. RandonLA Cliniques Universitaires St. Luc, Bruxelles L. De PauwLG Centre Hospitalier Universitaire, LiègeLM Universitair Ziekenhuis Gasthuisberg, LeuvenGermanyBB Knappschaftskrankenhaus, Bochum P. SchenkerBC Charité-Campus Virchow Klinikum der Humboldt Universität, Berlin A. KahlDR Universitätsklinikum Carl Gustav Carus, Dresden S. KerstingER/NB Chirurgische Klinik der Universität Erlangen-Nürnberg, Erlangen V. MüllerES Universitätsklinikum, Essen A. PaulFM Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt C. MönchFR Klinikum der Albert-Ludwigs-Universität, Freiburg P. PisarskiHB Klinikum der Ruprecht-Karls-Universität, Heidelberg J. SchmidtHG Universitäts-Krankenhaus Eppendorf, Hamburg L. FischerHO Klinikum der Medizinischen Hochschule, Hannover Th. BeckerJE Friedrich Schiller Universität, Jena U. SettmacherKI Klinikum der Christian-Albrechts-Universität, Kiel F. BraunKL Klinik der Universität Köln-Lindenthal, Köln D. StippelKM Kliniken der Stadt Köln gGmbH, Krankenhaus Merheim, Köln-Merheim, Köln D. StippelLP Klinikum der Universität, Leipzig D. UhlmannLU Klinikum der Medizinischen Universität, LübeckMH Klinikum Rechts der Isar der Technischen Universität, München P. BüchlerML Klinikum Großhadern der Ludwig-Maximilians-Universität, München H. ArbogastMR Klinikum Lahnberge der Philipps-Universität, Marburg J. HoyerMZ Klinikum der Johannes-Gutenberg-Universität, Mainz M. HeiseRB Klinikum der Universität, Regensburg S. FarkasRO Klinikum der Universität, Rostock E. KlarTU Klinikum der Eberhard-Karls-Universität, Tübingen S. NadalinThe NetherlandsGR Academisch Ziekenhuis, Groningen R. PloegLB Leids Universitair Medisch Centrum, Leiden J. RingersCroatiaZM Clinical Hospital Merkur, Zagreb S. Jadrijevićtissue typing laboratories DelegateAustriaGA Universitätsklinik, Abteilung für Transfusionsmedizin und Immunohämatologie, Graz A. HelmbergIB Universitätsklinik, HLA Labor, Innsbruck A. Mühlbacher12
  14. 14. OL Allgemeines Krankenhaus, Blutzentrale, Linz C. GabrielOW Allgemeines Krankenhaus, HLA Labor, Wels R. LoizenbauerWG Institut für Blutgruppenserologie, Wien W. MayrBelgiumBJ Universitair Ziekenhuis Brussel, Bloedtransfusiecentrum Jette C. DemanetBR Hôpital Erasme, Tissue typing laboratory, Bruxelles M. AndrienLA Université de Louvain, Tissue typing laboratory, Bruxelles D. LatinneLG Laboratoire des Groupes Sanguins, Liège G. MaggipintoME Rode Kruis Vlaanderen, Laboratory for Histocompatibility & Immunogenetics (HILA), Mechelen M.-P. EmondsGermanyBC Charité-Campus Virchow Klinikum der Humboldt Universität, Berlin C. SchönemannDU Institut für Transplantationsdiagnostik und Zelltherapeutika, Düsseldorf J. RoxER/NB Institut für Klinische Immunologie, Erlangen B. SpriewaldES Universitätsklinikum, Institut für Immunologie, Essen F. HeinemannFM Immunohaematologie, Blutspendedienst Hessen, Frankfurt C. SeidlFR Blutspendedienst, Labor für Gewebetypisierung, Freiburg F. EmmerichGI Institut für Klinische Immunologie und Transfusionsmedizin, Gießen S. WienzekGO Klinikum der Universität, HLA Labor, Göttingen H. NeumeyerHA Institut für Phathologische Biochemie, Interdisziplinäres Typisierungslabor, Halle W. AltermannHB Institut für Immunologie und Serologie, Heidelberg C. SüsalHG Universitäts-Krankenhaus Eppendorf, HLA Labor, Hamburg T. BinderHO Klinikum der Medizinischen Hochschule, Immunohaematologie/Blutbank, Hannover M. HallenslebenKI Klinikum der Christian-Albrechts-Universität, HLA Labor, Kiel M. MargetKM Institut für Transfusionsmedizin, Köln-Merheim, Köln U. BauerfeindKS Institut für Rechtsmedizin, Transplantationsimmunologie, Kaiserslautern B. ThieleLU Institut für Immunologie und Transfusionsmedizin, Lübeck M. ZiemannML Kinderklinik der Ludwig-Maximilians-Universität, HLA Labor, München M. SpannaglGMN Institut für Transfusionsmedizin, MünsterMZ Klinikum der Johannes-Gutenberg Universität, HLA Labor, Mainz W. HitzlerRO Klinikum der Universität, Abteilung für Transfusionsmedizin, HLA Labor, RostockST Klinikum Stuttgart, Zentralinstitut für Transfusionsmedizin und Blutspendedienst, Stuttgart A. EnderTU Klinikum der Eberhard-Karls-Universität, Abt. für Transfusionswesen und Blutbank, TübingenUL DRK Blutspendezentrale, Transplantationsimmunologie, Ulm J. MytilineosLuxembourgLX Centre Hospitalier, HLA Lab, Luxembourg F. HentgesThe NetherlandsAW Centraal Laboratorium Bloedtransfusiedienst, Nederlandse Rode Kruis, Amsterdam N. LardyGR Laboratorium voor transplantatie-immunologie, Groningen S. LemsLB Leiden University Medical Centre, Immunohaematologie, Leiden F. ClaasMS Academisch Ziekenhuis, Laboratorium voor weefseltypering, Maastricht M. TilanusNY Academisch Ziekenhuis St. Radboud, Bloedtransfusiedienst, Nijmegen W. AllebesUT Academisch Ziekenhuis, Bloedbank, Utrecht H. OttenSloveniaLO Tissue Typing Centre, Blood Transfusion Centre, Ljubljana B. Vidan-JerasCroatiaRI Clinical Hospital Center, Tissue Typing Laboratory, Rijeka N. KatalinićZA University Clinical Hospital, Zagreb R. ZunecETRL Eurotransplant Reference Laboratory, Leids Universitair Medisch Centrum, Leiden, The Netherlands F. Claas, I. Doxiadis 13
  15. 15. 14
  16. 16. forewordWe hereby present to you the Annual Report report of 2009 of the Eurotransplant (ET) International Foundation. The objectiveof 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 theFoundation 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 reachthe goals associated with its mission. Obviously the good work was done by doctors and nurses of the donor hospitals andthe 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 addressthe organizational issues and risks that were identified in this plan in order to prepare our organization adequately for thefuture. Also, following the request of two potential new member states, discussions on possibilities to cooperate were startedwith 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 MBAPresident Medical Director General DirectorLeiden, April 2010 15
  17. 17. 1. report of the Board and the central office of Stichting Eurotransplant International (ET) foundationE. Houwaart, R. Cranendonk and A. Oosterlee, Eurotransplant International Foundation, the NetherlandsThe Board of Stichting Eurotransplant International Foundation met on January 22, May 18 and September 30 & October2, 2009. Three Board members A were (re)-elected by the Assembly. Prof.Dr. Uwe Heemann and Prof.Dr. Caner Süsal wereelected as members A in the kidney and tissue typing section respectively. Prof.Dr. Günther Laufer was re-elected in thethoracic section. The Board took leave of Prof.Dr. Rutger Ploeg and Dr. Joannis Mytilineos. Prof.Dr. Guus van Montfort wasre-elected by the Board as a member D in the field of finance. Prof.Dr. Uwe Heemann was elected as chairman of the ETKACin succession to Prof.Dr. Hans de Fijter.1.1 report of the eurotransplant boardDuring its first meeting in 2009, the Board continued the discussion on the position of the intestine in relation to the organallocation sequence. It was explained that due to the fact that from pediatric organ donors only either the pancreas or theintestine can be offered, pediatric patients awaiting an intestine transplantation are in a disadvantage. The discussion resultedin 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 discussnew recommendations and changes in a transparent and time efficient way. This joint meeting was organized for the first timeon October 2, 2009 in conjunction with the annual ET meeting. The meeting was considered to be an opportunity to discusstopics from different perspectives, which might lead to valuable new insights. One of the topics discussed was the abovementioned pancreas/intestine procurement and rescue allocation. With regard to pancreas/intestine procurement, the Boarddecided 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:EFRETOSThe 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 ofregistries on the follow-up of organ recipients. The project officially started in May 2009 after a kick-off meeting which wasattended by all leaders of the work packages. Completion of the project was expected to be a fact within 24 months.Friends of EurotransplantThe Board approved the constitution of the Board of the Friends of Eurotransplant Foundation, in which initially four membershave a seat. The Board will continue to search for further Board members of the Friends of Eurotransplant Foundation.Implementation of the ET general conditionsDuring the first 2009 meeting, the Board was informed that one ET country had not yet accepted and another had onlyacknowledged the general conditions. The general conditions are important to ET as in these conditions the distribution ofresponsibilities and thus liabilities between ET and the transplant centers are clearly defined (e.g. the centers rather than ET areresponsible for patient data in the ET waiting lists). In the course of the year, the chairman of the German Bundesärztekammerinformed ET that the general conditions contain two issues that cannot be approved by Germany. These issues concernlimitation of liability and the fact in case of a dispute the Dutch law is valid. Subsequently, discussions took place in order tofind a solution which resulted in a new draft of the general conditions. German approval of this version is still pending.16
  18. 18. The possible hosting of an ISHLT database and setting up a VAD registry project was postponed. The current global financialcrisis 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 Europeancountries – among others Estonia and Serbia – in order to establish possible cooperation. This is a continuing process, onwhich the Board will be kept updated. ET will furthermore research the possibility to get official support by EU for openingup to new countries.A representative of the Estonian transplant community had been invited to one of the Board meetings to give a presentationon the Estonian organ donation and transplantation system. This presentation resulted in the Board agreement to go aheadwith 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 donationand transplantation system. It was decided to also continue the establishment of cooperation with Serbia and to evaluatethe progress during the Board meeting in Alpbach, Austria on January 27, 2010. Furthermore, the Board decided that otherEuropean 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 preliminarycooperation.The establishment of cooperation with potential new ET member states also resulted in the idea of setting up an ET collegefor the training of medical professionals in the field of organ donation and transplantation. It was decided to bring this issueforward 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 allET countries and Spain were given. The purpose of information exchange had been fulfilled and there was no need to continuethe platform. In order to maintain a direct communication structure with the competent national authorities within ET, theBoard 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 tothe meeting. The participants acknowledged the council as an official body. The main topics discussed during the first meetingwere 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. Asa result, ET will be able to implement the most important recommendations from ET’s policy planning project, such asreinforcement of several departments and establishing a central communication function. The Board was also informed thatthe reserves of ET increased in the course of 2009. In this respect the Board decided to further increase the reserves in thecoming years, in order to be able to deal with any unexpected events. In the course of the year 2009 the Board approved theannual 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 tobe negotiated separately in the future. As a consequence of implementing this new budgetary system, it was necessary toformalize 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 Mandatewhich has the support of all national authorities within ET. This ET Basic Mandate was approved by the ET contract partnersduring 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 theVienna 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 lungtransplantation. The aim of this cooperation is that all Croatian patients awaiting lung transplantation will be transplanted inVienna. All lungs from Croatian donors will be handled as local donors of the Vienna lung transplant program. 17
  19. 19. Following a request of the Belgian Transplantation Society, the Board approved support of the Belgian cross-over programby ET.A new version of a document on practical handling of data analysis requests including a classification overview of types ofrequests was presented and approved. This overview describes which type of requests will be carried out in the framework ofET’s Basic Mandate and which type of requests have to be paid for by the requestors. The main idea is that requests involvingsubstantial workload for the data analysis on the side of ET should only be done if the request is approved by the respective ETscientific Advisory Committee. For larger projects every effort should be made to find external financial sources to compensatefor 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 thebest paper composed by authors from the ET region and published in the last year. A selection committee had been formedand 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 aconsensus meeting in Belgium to which all Belgian specialists in the field of organ donation and transplantation were to beinvited. 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 toEU 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 transplantcenters 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 of2009.It was discussed by the Board whether ET should establish a reference laboratory for virology testing. Also, since it wasdetermined that laboratory values vary, it was discussed whether ET should set standards for laboratory values. It was decidedto research current standards for laboratory values and to further discuss this issue in the OPC and during the ET wintermeeting in Alpbach, Austria.In view of increasing activities in transplanting composite tissues, for example for hand or face transplantation, it was suggestedto draw the attention of the European Commission to the fact that ET has the aspiration to become the responsible organizationfor allocation of hepatocytes, islets and composite grafts. Since ET has the experience and facilities for quick guidance of theprocess 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 officeFor ET, 2009 can be seen as a year in which many steps were taken to specify and further professionalize its services toprofessionals 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 ourusers.An important step was the formal specification of the responsibilities and main services of ET in ET’s so-called BasicMandate (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 wasset up (Information Services) to prepare and implement policies in the field of business and information activities, whichacts as an intermediary between the primary and supportive processes. Program management was introduced and projectmanagement was reinforced. Functional and technical application maintenance and support was restructured and the testingprocess improved.18
  20. 20. The following processes and activities are reported according to the services mentioned in the Basic Mandate.Allocation servicesThe allocation process improved through reinforcement of the staff of the Medical Administration with the long term focusof a 24/7 regular staff attendance.An electronic donor log application was developed for registration per donor of deviations in the allocation process whichpreviously 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 processIn the area of data collection and analysis a ‘Registry Policy Plan’ was developed and preparations for executing the plan weremade. Meanwhile projects and pilots were started to anticipate the implementation of the policy. The European EFRETOSproject and the ET registry policy were harmonized wherever appropriate. Reinforcement of the biostatistical capacity wasstarted 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 patientswas 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 forislets and pancreas allocation was developed and implemented by December 2009, thus filling the existing gap.External networkingIn the field of external networking several important developments took place: the ET Council was established giving nationalauthorities a formal platform to discuss issues and concerns on a supranational level with the Board of ET. This Council metonce and formalized ET’s above mentioned Basic Mandate.Another formal step taken was the formalization of a service level agreement (SLA) between the Nederlandse TransplantatieStichting (NTS) and ET. In this document the terms of the contract between ET and the NTS are annually specified. It alsodistinguishes 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 ofET’s winter meeting however, was changed after 25 years. In contrast to previous winter meetings, this meeting was openedup to everyone with an interest in ET. The audience was welcomed in the professional congress center Alpbach, Tirol and waspresented 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 anexternal consultant. A start was made with hiring a regular communication officer. Also a plan was developed and partiallycarried out to evaluate our corporate design and the external website and member site.Information and qualityIn the field of information management, steps were taken to improve cooperation via a method of sharing documents andpreliminary 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 andmaintenance.ET underwent several external audits in 2009. ET’s quality assurance system was externally audited by Veritas. Our systemswere positively evaluated. A recommendation for improvement was in the meantime been addressed. As from February 2010ET is accredited for ISO 9001: 2008. In 2009, the German as well as the Dutch national transplant authorities audited ET’sorganization and services. Both the German ‘Prüfungskommission’ as well as the NTS determined that ET was delivering itsservices according to its formal obligations.FinanceIn the financial field, steps were taken in the enhancement of systems for budgeting, reporting and costing. Budget forecastingwas 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 strategyand policy. 19
  21. 21. PersonnelIn 2009 a start has been made to adapt the staffing of the duty desk according to strategy. It is intended to expand thisfunction to each shift in the future to further assure the quality of our allocation process.Information servicesThe planning and control systems for functional and technical development as well as maintenance of ET’s softwareapplications were given a boost this year. A function was set up for project and program management as well as testcoordination. In its short existence a significant improvement in management information was achieved which stronglyenhances prioritization, planning and decision making by the directors.1.3 Future policyAlso in 2011, the ET Policy Plan 2009-2013 will provide guidance for developing plans and activities. The consolidationstrategy will be sustained, whereas we will remain open for discussion with countries that want to explore possibilities forcooperating 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 & safetyApart from the yearly regular quality issues, such as updating the ET-manual, the year 2009 was characterized by twospecial issues.First the implementation process of the ISO 9001:2008 regulations was continued. Secondly the evaluation of severalaspects of our internal and external communication as well as the evaluation of our incidents management system tookplace. During the past two years the risk awareness of our employees significantly increased. The incident registrationsystem was analyzed and further developed in order to support systematic improvement of the allocation process. Theimprovements will be implemented in 2010.Safety management and patient safetySafety management covers different area’s, such as patient safety, minimization of liability risks and financial safety. ETservices 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 atransparent and crystal clear outline of all rules and criteria regarding every organ.IncidentsThe risk awareness of the employees further improved as the number of near-incidents and incidents identified and reportedincreased (see table below). For this reason it is essential to develop a system for continuous learning, which will beimplemented 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 61120
  22. 22. Almost all of the incidents with an internal cause were incidents in incomplete administration, which led to extraadministrative operations, such as re-examining the donor log. Incidents with an external cause were discussed with theresponsible parties/persons/organizations, such as transplant coordinators and transport companies.ComplaintsSince October 1, 2008 an e-mail address (complaints@eurotransplant.org) for complaints and suggestions is placed on themember 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. Inall 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 partiesAlthough certification according to ISO 9001:2000 is valid for another year, ET is now certified according to ISO9001:2008.The yearly investigation by the German Prüfungskommission led to a satisfactory outcome.The audit by the NTS was successful as well.Internal auditsBesides the regular audit issues a theme audit, concerning communication, was done. Several weak points were discernedand acted upon.1.5 advisory committeesThe Board discussions, among other issues, concentrated on the proposed recommendations by the various AdvisoryCommittees. Obviously, the work done in these committees contributes to improve the core of the business, namely: state ofthe art allocation. The Board is grateful for all the time and efforts the Committee members have provided to this importantpart of the work of ET.ET positions itself as an independent scientifically oriented organization. Various organ Advisory Committees, of whichthe chairmen hold a position in the Board of ET, meet several times a year and discuss the impact of new scientificdevelopments in the field of organ allocation, organ procurement as well as transplant ethics. Their conclusions areproposed as recommendations to the Board of ET. In the respective member states national transplant authorities authorizerecommendations approved by the ET Board, sometimes with slight adaptations to the national circumstances. A completelist 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 approvedand 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 RemarksProf.Dr. U. Heemann, Munich 05.2009 chairman, representative BoardProf.Dr. F. Mühlbacher, Vienna 09.1994 representative AustriaProf.Dr. A. Rosenkranz, Innsbruck 01.2008 representative AustriaDr. P. Duhoux, Luxembourg 09.1994 representative LuxembourgDr. K. Wissing, Brussels (BJ) 01.2004 representative BelgiumDr. P. Peeters, Ghent 02.2006 representative BelgiumVacancy 05.2009 representative GermanyProf.Dr. U. Kunzendorf, Kiel 01.2002 representative GermanyProf.Dr. B. Krämer, Bochum 01.2006 representative GermanyProf.Dr. P. Fornara, Halle 11.2006 representative GermanyDr. J. Homan van der Heide, Groningen 04.2005 representative the NetherlandsDr. L. Hilbrands, Nijmegen 01.2006 representative the NetherlandsDr. M. Arnol, Ljubljana 01.2006 representative SloveniaProf.Dr. J. Pasini, Zagreb 04.2008 representative Croatia 21
  23. 23. Prof.Dr. F.H.J. Claas, Leiden (ETRL) 09.1994 representative TT AssemblyDr. J. de Boer, Eurotransplant 12.2005 secretaryLIVER INTESTINE ADVISORY COMMITTEE (ELIAC)Name As of RemarksProf.Dr. R. Rogiers, Ghent 09.2007 chairman, representative BoardProf.Dr. R. Steininger, Vienna 11.2004 representative AustriaDr. O. Detry, Liège 01.2000 representative BelgiumProf.Dr. P. Michielsen, Antwerp 01.2008 representative BelgiumProf.Dr. P. Neuhaus, Berlin 09.1994 representative GermanyProf.Dr.N. Senninger, Münster 01.2004 representative GermanyProf.Dr. G. Otto, Mainz 01.2008 representative GermanyProf.Dr. R. Porte, Groningen 01.2006 representative the NetherlandsDr. V. Sojar, Ljubljana 01.2008 representative SloveniaDr. B. Kocman, Zagreb 04.2008 representative CroatiaDr. A. Rahmel, Eurotransplant 02.2007 secretary a.i.PANCREAS ADVISORY COMMITTEE (EPAC)Name As of RemarksProf.Dr. W. Schareck, Rostock 12.2005 chairman, representative BoardProf.Dr. P. Hengster, Innsbruck 11.2004 representative AustriaProf.Dr. C. Mathieu, Leuven 02.2006 representative BelgiumDr. H. Arbogast, Munich 03.2009 representative GermanyProf.Dr. R. Viebahn, Bochum 11.2004 representative GermanyDr. A. Kahl, Berlin 01.2006 representative GermanyDr. J. Ringers, Leiden 04.1998 representative the NetherlandsDr. A. Tomazič, Ljubljana 01.2007 representative SloveniaDr. S. Jadrijević, Zagreb 04.2008 representative CroatiaProf.Dr. F.H.J. Claas, Leiden (ETRL) 08.1994 representative TT AssemblyDr. K. Kovac, Eurotransplant 10.2009 secretaryTHORACIC ADVISORY COMMITTEE (EThAC)Name As of RemarksProf.Dr. G. Laufer, Vienna 10.2001 chairman, representative BoardProf.Dr. A. Wasler, Graz 11.2001 representative AustriaProf.Dr. A. Zuckermann, Vienna 01.2008 representative AustriaProf.Dr. P. Evrard, Brussels (LA) 01.2004 representative BelgiumProf.Dr. M. Depauw, Ghent 01.2006 representative BelgiumDr. P. Überfuhr, Munich 02.2006 representative GermanyDr. U. Schulz, Bad Oeynhausen 05.2006 representative GermanyProf.Dr. H. Reichenspurner, Hamburg 02.2008 representative GermanyDr. H. Bittner, Leipzig 02.2008 representative GermanyDr. W. van der Bij, Groningen 06.2001 representative the NetherlandsDr. N. de Jonge, Utrecht 01.2004 representative the NetherlandsProf.Dr. I. Kneževič, Ljubljana 07.2007 representative SloveniaProf.Dr. Z. Sutlić, Zagreb 04.2008 representative CroatiaDr. J. Smits, Eurotransplant 07.2002 secretaryORGAN PROCUREMENT COMMITTEE (OPC)Name As of RemarksProf.Dr. D. Ysebaert, Antwerp 10.2005 chairman, representative BoardProf.Dr. G. Berlakovich, Vienna 11.2009 representative TC’s AustriaMs. G. Van Beeumen, Antwerp 02.2006 representative TC’s BelgiumDr. N. Frühauf, Hanover 01.2008 representative DSO GermanyProf.Dr. E. Klar, Rostock 01.2008 representative TC’s GermanyMs. J. Hagenaars, Rotterdam 04.2008 representative TC’s NL22
  24. 24. Dr. B. Trotovšek, Ljubljana 01.2008 representative SloveniaDr. Z. Zupan, Rijeka 04.2008 representative CroatiaProf.Dr. F. Mühlbacher, Vienna 11.2009 representative ETKACDr. O. Detry, Liège 01.2000 representative ELIACDr. J. Ringers, Leiden 04.2002 representative EPACProf.Dr. A. Zuckermann, Vienna 04.2008 representative EThACProf.Dr. I. Doxiadis, Leiden (ETRL) 02.1998 representative TTACDr. I. Tieken, Eurotransplant 09.2007 secretaryCOMPUTER SERVICES WORKING GROUP (CSWG)Name As of RemarksProf.Dr. F. Mühlbacher, Vienna 09.1995 chairman, representative Board + ETKACDr. R. Kramar, Wels 09.1995 representative AustriaMr.W. Van Donink, Antwerp 10.2009 representative BelgiumDr. M. Schenk, Tübingen 01.2008 representative GermanyDr. A. Hoitsma, Nijmegen 09.1995 representative the NetherlandsMr. T. Campelj, Ljubljana 01.2006 representative SloveniaVacancy representative ELIACDr. W. van der Bij, Groningen 05.2002 representative EThACDr. S. Lems, Groningen 06.1996 representative TTACDrs. T. Valkering, Eurotransplant 05.2008 secretaryTISSUE TYPING ADVISORY COMMITTEE (TTAC)Name As of RemarksProf.Dr. F.H.J. Claas, Leiden (ETRL) 09.1995 chairman, representative BoardProf.Dr.W. Mayr, Vienna 01.2008 representative AustriaProf.Dr. M.-P. Emonds, Leuven 02.2006 representative BelgiumDr. F. Hentges, Luxembourg 09.1995 representative LuxembourgDr. C. Schönemann, Berlin 11.2002 representative GermanyDr. J. Mytilineos, Ulm 01.2006 representative GermanyDr. S. Lems, Groningen 09.1995 representative the NetherlandsDr. B. Vidan Jeras, Ljubljana 12.1999 representative SloveniaProf.Dr. R. Zunec, Zagreb 04.2008 representative CroatiaProf.Dr. I.I.N. Doxiadis, Leiden (ETRL) 09.1995 secretaryETHICS COMMITTEE (ETEC)Name As of RemarksProf.Dr. P. Schotsmans, Leuven 01.2001 chairman, representative BoardDrs. M. Bos, The Hague 05.1995 vice-chairman, representative the NetherlandsProf.Dr. W. Schaupp, Vienna 04.1998 representative AustriaProf.Dr. I. Kerremans, Ghent 03.2004 representative BelgiumProf.Dr. R. Viebahn, Bochum 11.2006 representative GermanyDr. D. Rigler Pleterski, Ljubljana 01.2000 representative SloveniaDr. J. Stoić Brezak, Zagreb 04.2008 representative CroatiaDr. A. Rahmel, Eurotransplant 12.2006 secretary a.i.FINANCIAL COMMITTEE (FC)Name As of RemarksProf.Dr. A.P.W.P. van Montfort, Utrecht 05.2003 chairman, representative BoardMag. O. Postl, Vienna 05.1995 representative AustriaProf.Dr. D. Ysebaert, Antwerp 05.1995 representative BelgiumProf.Dr. B. Reichart, Munich 03.2009 representative GermanyMs. M. Konda, Ljubljana 01.2006 representative SloveniaDrs. T. Valkering, Eurotransplant 05.2008 secretary 23
  25. 25. 1.6 recommendations approvedIn 2009, the following recommendations were submitted by the Advisory Committees and approved by the Board ofEurotransplant International Foundation:Kidney advisory committee (etKac)rKac01.09If one or more consecutive kidney transplants fail requiring maintenance dialysis within 3 months after transplantation, andthe recipient is re-entered on the waiting list, waiting time will be returned starting from the dialysis time before the firstfailed transplant.rKac02.09Children either on dialysis or registered on the ET waiting list before the age of 16, should be granted a pediatric status untiltheir first successful graft, irrespective of their age at the time of an offer. In case of a pre-emptive registration on the kidneywaiting 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 providedthat they are proven to be in maturation. This proof has to be delivered by the transplant center by a report of a competentradiologist or pediatric endocrinologist on an X-ray of the left hand that has to be sent to and judged on by two independentauditors 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 whenthe recipient fulfils above criteria for maturation at time of institution of dialysis.The effect of these changes should be evaluated after 2 years.rKac03.09In case of a donor <16 years of age recipients having the pediatric status are listed directly after 000 HLA mismatchedrecipients, provided that the recipient specific donor profile on maximum donor age and accepted HLA mismatches is enteredinto ENIS. The ranking order among these recipients should be according to the ETKAS overall point score system.rKac04.09The current, age dependent, pediatric bonus should be replaced by a uniform bonus of 100 points for al recipients having thepediatric status.liver intestine advisory committee (eliac)rlac01.09Establishment 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.rlac03.09In case for a patient an ACO status for combined transplantation is granted according to the established ACO rules and thepatient in addition receives the HU status according to the organ specific criteria for one of the organs for which the ACOstatus is granted, the patient will be listed in HU status for all the organs he/she is waiting for.24
  26. 26. In case of a pediatric patient (recipient at time of listing below the age of 12) the initial match MELD shall reflect an expected3-month mortality of 35%. The matchMELD shall then be increased 3-monthly according to an increase in expected mortalityon the waiting list by 15%.pancreas advisory committee (epac)rpac01.09The EPAC recommends abandoning granting (international) SU-status for pancreas islet retransplantation.rpac02.09Any pancreas, independent of donor age and BMI, should first be offered to ACO (Approved Combined Organ) and SU statusrecipients.thoracic advisory committee (ethac)rthac02.07 rephrasedUpon the request for upgrading of an urgency status for heart and/or lung transplant candidates auditors need to provide ananswer to the ET allocation office within 6 hours after the request has been sent. In case auditors have additional questionsrelated to the request, these will be forwarded to the requesting center by ET and the requesting center has to answer within6 hours after these questions were received. In case the requesting center does not agree with the auditors’ decision, therequesting center has maximal one opportunity of putting forward its objection. The auditors’ decision in the second roundis 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).rthac02.09The EThAC recommends using the ET Code of Conduct for Thoracic Auditors as a leading document for addressing HUrequests.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 thistumor.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. 25
  27. 27. tissue typing advisory committee (ttac)rttac01.09In case the HLA-typing is available prior to the start of allocation, a kidney match has to be performed first. If there is arecipient on the AM-mismatch kidney transplant waiting list, who is in need of a combined transplantation, the kidney andnon-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).rFc01.09The Financial Committee recommends the Board to approve the final budget proposal 2009.rFc02.09The Financial Committee recommends the Board to approve the annual accounts 2008.rFc03.09The Financial Committee recommends the Board to approve the budget proposal 2010.*Submitted by the end of 2008, but accepted by the beginning of 2009.26

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