What does allocation development mean?
Which organs from which donors are suitable for transplantation? And to which patient should a specific organ be allocated? How is it decided which patient gets priority over another patient on the waiting list? These critical questions form just part of the work of the allocation development process within Eurotransplant. In order to continuously improve the allocation process data is constantly analyzed and careful checks and balances are always in place to ensure that all medical and ethical standards are adhered to while seeking for optimal matches between donor organs and selected patients.
The quest to allocate a suitable organ to the best patient at the right time
Allocation development has one aim: to continuously improve the match between donor organ and patient.
The ultimate goal is that more recipients with a donor organ not only survive and live longer, but also enjoy a higher quality of life. It is a continuous quest to allocate the right organ to the best patient at the optimal time. And in this quest Eurotransplant uses all available information: results from internal analyses of the Eurotransplant database and Eurotransplant Registry, data provided by the patients, the transplant centers and via exchange with other registries as well as results from international research. The goal of using this information is developing recommendations with the best possible scientific basis for further adaptation of allocation rules.
A thorough analysis of all steps involved
The key is to try and to predict with the greatest possible accuracy which particular patient has the greatest need/urgency for a transplant and at the same time is likely to benefit the most from a donor organ. This requires a painstaking analysis of all steps involved in the transplantation process – from registration on the waiting list to donor reporting, organ allocation, transplantation and follow-up.
1. Registration on the transplant waiting list
What kind of medical information is required for registering a patient on the transplant waiting list? How often does this data need to be updated based on medical examinations? And what information attributes are specific to allocation development?
2. Donor reporting
What kind of data on the donor and the donor organ need to be reported in order to enable a good donor-patient match? Which information plays a decisive role in the evaluation of which organs are suitable for transplantation and which are not?
3. Allocation
What is the best match between a donor organ and a patient? How is the ranking of the patients on the match list? Which factors determine a patient’s position on the list? What happens with the match in the event new information on the donor or the patient becomes available or if information changes?
4. Transplantation
What kind of techniques are used? How long can an organ be preserved outside the human body? What are the critical factors for a successful outcome after a transplantation?
5. Follow-up
How do recipients recover after transplantation? Which recipients have the best chance of survival? And which recipients do not benefit from transplantation?
Registry and biostatistics
Donor hospitals, donor organizations and transplant centers in the Eurotransplant member states keep a careful record of data of waiting list patients, donors, transplants and follow-up in order to collect complete data on the follow-up, for example: what happens to recipients after they have received a donor organ? How many transplants and recipients survive the years after transplantation? How many recipients die despite receiving a donor organ? How many organ transplants were unfortunately unsuccessful? And for which reason? The Eurotransplant Registry is a good example of data-collective collaboration between Eurotransplant and the transplant centers in the Eurotransplant member states.
Although it is often difficult to retrieve 100% of these data items, they play a crucial role in refining organ allocation. It is an invaluable piece in the puzzle that needs to be solved in order to predict which type of recipients stand the best chance of survival with which type of organs. Analyzing the various data sets is the task of the medical doctors at Eurotransplant and the biostatisticians either working at Eurotransplant or in the transplant centers. These analyses often generate new findings which in turn lead to recommendations for new rules on organ allocation. These are then forwarded to the National Competent Authorities in the member states. It is, however, up to them to decide if these recommendations are approved and integrated into the allocation guidelines, whenever possible on an international level, but sometimes also only on a national level.
Research
One of the goals of Eurotransplant is to further improve the results of transplantation through scientific research and through dissemination of the outcomes. Eurotransplant facilitates research by gathering data on donors, patients on the waiting list, recipients, transplants and the outcome of transplantation. This information is spread in various ways amongst the scientific and medical community.
Statistical data
Statistical data are published on Eurotransplant’s website, news updates and Annual Reports. The biostatisticians of Eurotransplant regularly assist scientists who have special requests for biostatistical data.
Presentations and lectures
Staff members of Eurotransplant frequently give presentations and lectures. They discuss various aspects of organ transplantation and the allocation of organs at national and international scientific meetings and conferences.
Eurotransplant Annual Meeting
Once a year, Eurotransplant organizes a meeting for the transplant community from within and from outside the Eurotransplant member states. On purpose of disseminating outcomes of recent research, the meetings of the Assembly, the Supervisory Board and the Advisory Committees are combined with a scientific program.