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2012 NEWSLETTER TRANSPLANT COUNCIL OF EUROPE CONSEIL DE L’EUROPE Vol. 17 • Nº 1 • SEPTEMBER • 2012 INTERNATIONAL FIGURES ON DONATION AND TRANSPLANTATION - 2011
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Newsletter Europe 2012
Transcript of Newsletter 2012
2012
NEWSLETTERTRANSPLANT
COUNCILOF EUROPE
CONSEILDE L’EUROPE
Vol
. 17
• N
º 1
• SE
PT
EM
BE
R •
201
2
INTERNATIONAL FIGURES ONDONATION AND TRANSPLANTATION - 2011
Editor: Rafael Matesanz
AULA MÉDICA EDICIONES. Paseo Pintor Rosales, 26 - 28008 Madrid (España)Tel. 91 357 66 09. Fax 91 357 65 21. Depósito legal: M-9.990-1996. ISSN: 2171-4118.
NATIONAL DATA PROVIDED BY:
Organización Nacional de Trasplantes (ONT) – SpainRafael MatesanzBeatriz MahilloMarina AlvarezMar Carmona
AUSTRIAJacqueline Smits (ET)BELGIUMJacqueline Smits (ET)BULGARIAVioletta MarinkovaCYPRUSPanayiotis HadjicostasChrystalla DespotiMaurizio Di Fresco (MTN)CZECH REPUBLICLucie BaudyšováDENMARKFrank Pedersen (SKT)ESTONIAPeeter DmitrievFINLANDFrank Pedersen (SKT)FRANCECristelle CantrelleMarie ThuongGERMANYBrigitte OssadnikJacqueline Smits (ET)GREECEAnastasios HatzisGeorgia MenoudakouMaurizio Di Fresco (MTN)HUNGARYSz cs AnikóIRELANDMaeve RaesideITALYAndrea RicciPaola Di CiaccioLATVIASergey TrushkovLITHUANIAVita AnulytèLUXEMBURGJacqueline Smits (ET)MALTACarmel AbelaMaurizio Di Fresco (MTN)NETHERLANDSRik van LeidenJacqueline Smits (ET)POLANDPiotr MalanowskiPORTUGALCatarina BolotinhaROMANIADan Adrian LuscalovSLOVAKIALudovit LacaSLOVENIABarbara UštarJacqueline Smits (ET)
SPAINElisabeth CollCarmen MartínDavid UruñuelaSilvia MartínSWEDENFrank Pedersen (SKT)UNITED KINGDOMMark Jones
(ET) EUROTRANSPLANTAustria, Belgium, Croatia,Germany, Luxemburg,Netherlands and Slovenia
(SKT) SCANDIATRANSPLANTDenmark, Finland, Norway,Sweden and Iceland
ALGERIAFarid HaddoumMaurizio Di Fresco (MTN)AUSTRALIALee ExcellKylie HurstBELARUSAleh RumoCANADAPatrick BedfordLiz Anne Gillham-EisenCROATIAJacqueline Smits (ET)EGYPTAhmed GhaliMaurizio Di Fresco (MTN)GEORGIAGia TomadzeICELANDFrank Pedersen (SKT)ISRAELTamar AshkenaziLIBYAMunir AbudherAsem BukrahMaurizio Di Fresco (MTN)LEBANONAntoine EstephanMaurizio Di Fresco (MTN)MACEDONIAGoce SpasovskiMOLDOVAIgor CodreanuTatiana TimbalariNEW ZEALANDLee ExcellKylie HurstNORWAYFrank Pedersen (SKT)
PALESTINEMohammed AyyoubMaurizio Di Fresco (MTN)RUSSIAYan MoysyukSWITZERLANDFranziska BeyelerDagmar VernetSYRIABassam SaeedMaurizio Di Fresco (MTN)TUNISIAHafed MestiriBen Abdallah TaiebMaurizio Di Fresco (MTN)TURKEYTürkay SeyhanBahri KemaglouMaurizio Di Fresco (MTN)USAJohn Rosendale
(MTN) MEDITERRANEANTRANSPLANT NETWORKAlgeria, Cyprus, Egypt, France,Greece, Israel, Italy, Lebanon,Lybia, Malta, Morocco,Palestine, Spain, Syria, Tunisiaand Turkey
ARGENTINACarlos SorattiMartín Alejandro TorresRicardo Rubén Ibarwww.grupopuntacana.orgBOLIVIAOlker Calla Rivadeneirawww.grupopuntacana.orgBRASILHeder Murari Borbawww.grupopuntacana.orgCHILEJose Luis Rojaswww.grupopuntacana.orgCOLOMBIAJuan Gonzalo López CasasDiana Carolina Plazas Sierrawww.grupopuntacana.orgCOSTA RICAMarvin Agüero ChinchillaCésar A. Gamboa Peñarandawww.grupopuntacana.orgCUBAAngela Olga Hidalgo Sánchezwww.grupopuntacana.orgDOMINICANAFernando Morales Billiniwww.grupopuntacana.org
ECUADORDiana Almeidawww.grupopuntacana.orgEL SALVADORMauricio Venturawww.grupopuntacana.orgGUATEMALARudolf García-Gallontwww.grupopuntacana.orgHONDURASMEXICOLuis Antonio Meixueiro DazaOmar Sánchez Ramírezwww.grupopuntacana.orgNICARAGUATulio René Mendieta Alonsowww.grupopuntacana.orgPANAMACesar Cuero Zambranowww.grupopuntacana.orgPARAGUAYHugo A. Espinoza C.www.grupopuntacana.orgPERUJuan A. Almeyda Alcántarawww.grupopuntacana.orgURUGUAYInés AlvarezRaul José Mizrajiwww.grupopuntacana.orgVENEZUELACarmen Luisa Lattuf de MilanésZoraida Pacheco Graterolwww.grupopuntacana.org
GRUPO PUNTA CANAArgentina, Bolivia, Brasil, Chile,Colombia, Costa Rica, Cuba,Dominicana, Ecuador, ElSalvador, España, Guatemala,Honduras, México, Nicaragua,Panamá, Paraguay, Perú,Portugal, Puerto Rico, Uruguayy Venezuelawww.grupopuntacana.org
NEWSLETTERTRANSPLANT 2012
CONTENTS• International Figures on Organ Donation and Transplantation Activity.
Year 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
• International Data on Organ Donation and Transplantation Activity,Waiting List, Family Refusals and Transplantation of VascularisedComposite Allografts. Year 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
• International Data on Tissues and Hematopoietic Stem Cell Donationand Transplantation Activity. Year 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
• Good Practice Guidelines in the Process of Organ Donation . . . . . . . . . . . . . 65
• Co-operation between countries of the Black Sea Area (BSA Project):Development of the activities related to donation and transplantation . . . . . 79
• Transplantation of Non-Nationals and Non-Residents in the Countriesof the Council Of Europe: Results of a Survey Conducted in theContext of the Initiatives of the European Committee on OrganTransplantation (CD-P-TO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
FOR THE PURPOSES OF THIS NEWSLETTER THE FOLLOWING DEFINITIONS WERE USED:
Actual deceased organ donorAn actual deceased organ donor is a person from whom at least one organ has been recovered for the purpose oftransplantation, in contrast to a utilised donor, who is an actual donor from whom at least one organ has beentransplanted. The number of utilised donors is therefore lower or equal than the number of actual donors.
Donor after brain deathA donor after brain death (DBD) is a deceased organ donor in whom death has been determined by neurologiccriteria.
Donor after circulatory deathA donor after circulatory death (DCD) is a deceased organ donor in whom death has been determined by circulatoryand respiratory criteria.
Multiorgan donorA multiorgan donor is an actual donor from whom at least two different types of organs have been recovered forthe purpose of transplantation.
Total TX. (all combinations included)Includes the transplantation of the corresponding organ with or without the simultaneous transplant of a differenttype of organ (s).
Double-kidney TX.One double-kidney TX. is counted as 1 TX.
TX. from living donorsA living donor is a living human being from whom organs have been recovered for the purpose of transplantation.A Living Donor has one of the following three possible relationships with the recipient:
A/ Related:A1/ Genetically Related:
1st Degree Genetic Relative: Parent, Sibling, Offspring2nd Degree genetic relative, e.g. grandparent, grandchild, aunt, uncle, niece, nephew,Other than 1st or 2nd degree genetically related, for example cousin
A2/ Emotionally Related: Spouse (if not genetically related); in-laws; Adopted; FriendB/ Unrelated = Non Related: Not Genetically or Emotionally Related
Heart-lung TX. One heart-lung TX. is counted as 1 lung TX., 1 heart TX. and 1 heart-lung TX.
Double-lung TX. One double-lung TX. is counted as 1 TX.
Total number of patients transplantedFor more than one organ transplanted into the same recipient: kidney-liver-heart TX. = counted as one recipient.
Absolute numberIncludes all figures corresponding to all donors/ patients adults and children.
PaediatricIncludes only paediatric activity (patients aged < 15 years).
Waiting List Example: At 1/1/2011 there were 200 patients active on the WL. Along the year, 100 patients are newly includedon the WL (first row). In total, 300 patients have been ever active on the WL during the year (second row). Alongthe year, 200 patients were transplanted (number recorded in a different questionnaire), 50 patients remain activeat the end of the year (third row), 25 patients died (fourth row) and 25 patients were excluded (number not to bereported, but derived from previous figures).
Patients included on the WL for the first time in the course of 2011 100
Total number of patients ever active on the WL during 2011 300
Patients awaiting for a transplant (only active candidates) on 31/12/2011 50
Patients who died while on the WL during 2011 25
(*The United Nations Fund report (UNFPA: http://www.unfpa.org/public/) is used as the data source for estimates ofpopulation size, unless a more up-to-date figure is available from an official source).
COUNCIL OF EUROPE
CONSEIL DE L’EUROPE3
International Figures on Organ Donation
and Transplantation Activity. Year 2011
6.7
24.5
15.5
17.2 16
.9 18.2
14.4
14.7
13.0
12.5
13.1
17.6
24.4
15.5
33.6
3.6 0.
5
6.9
4.2
21.8
35.3
25.0
12.5
20.7
17.0
13.6
30.1
18.0
28.1
11.8
10.0
3.3
5.5
2.3
4
10.8
30.0
0.6
AC
TU
AL
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D O
RG
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Rat
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. 201
1
36.7
60.4
46.3
32.8 33
.8 35.0
6.8
28.1
34.8
42.0
23.5
25.1
34.3
49.4
23.0
53.9
10.2
0.3
2.9
2.3
16.2
39.4
28.8
52.9
45.7
35.3
43.1
44.2
51.5
46.7
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22.7
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30.4 30
.8 33.6
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24.1
21.1
20.4
30.5
42.9
23.0 51
.8
6.7
1.0
1.1
12.2
7.0
3.5
25.3
46.3
41.1
22.6
36.7
27.7
25.1
43.1
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4.7
3.8
6.5 2.
0
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2.9
1.2
4.0
32.4
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6.6
4.6
12.6
6.0
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LIV
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7.8
14.7
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4.5
4.4
8.4
15.2
10.0
28.2
3.0
0.5
0.8
3.7
12.1
17.0
24.1
17.9
13.6
13.6
12.2
8.1
27.2
20.5
3.6
4.5
0.2
9.9
0.2
5.5
LIV
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6.0
5.5
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0.7
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4.5
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1.4
6.5 6.1 7.0
8.6
0.3 0.
3
0.5
1.2
4.6
5.0
6.3
4.5
1.3
2.4
2.6
6.9
4.3
1.5
2.2
1.4
3.0
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LUN
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5.6
6.4
4.3 2.
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0.1
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4.1
5.4
1.7
14.3
0.1
2.0
4.9
5.0
6.8
1.8
3.1
4.1
10.1
1.7
0.3
7.8
PAN
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4.0
3.7
0.2
0.1
0.9
2.1
1.0
3.0 1.9 0.5
2.7
0.1
0.3
1.0
2.4
1.1
3.5
1.8
3.8
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SMA
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36.7
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50.9 42
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61.4
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49.6 40
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0.3
2.9
3.4
20.4
52.6
52.1
86.4
73.0
61.5
42.7
62.6
67.2
75.9
28.2
25.1
4.0
20.2
16.4
11.7
17.5
10.3
3.6
47.5
0.8
22.6
14
EU
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TIM
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27
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International Data on Organ Donation andTransplantation Activity, Waiting List, FamilyRefusals and Transplantation of Vascularised
Composite Allografts. Year 2011
DO
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AN
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UN
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: htt
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/pub
lic/
8.4
11.0
7.4
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DO
NAT
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Act
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orga
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and
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clud
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(pm
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331
(30.
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(0.5
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(5.5
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73 (1
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22 (1
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93 (1
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149
256
26
105
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TRA
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all c
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(pm
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514
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(28.
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235
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13.3
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61.3
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7.3
10.1
Pae
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15 y
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1114
00
04
28
59TX
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m d
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360
(42.
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8 (1
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12 (1
0.9)
320
(30.
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5 (2
4.1)
40 (3
0.8)
164
(30.
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74 (4
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Sin
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TX. (
pmp)
358
(42.
6)46
7 (4
2.5)
8 (1
.1)
12 (1
0.9)
318
(30.
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4 (2
3.9)
37 (2
8.5)
164
(30.
4)26
18 (4
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Dou
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TX. (
pmp)
2 (0
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7 (0
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00
2 (0
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1 (0
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3 (2
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056
(0.9
)TX
. fro
m li
ving
don
ors
(pm
p)55
(6.5
)40
(3.6
)9
(1.2
)19
(17.
3)40
(3.8
)10
0 (1
7.9)
4 (3
.1)
13 (2
.4)
302
(4.6
)TX
. fro
m R
elat
ed li
ving
don
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(pm
p)-
-9
(1.2
)19
(17.
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(3.4
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(17.
7)4
(3.1
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(2.4
)30
2 (4
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TX. f
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Unr
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don
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(pm
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04
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m D
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(pm
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(1.9
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(8.3
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NA
2 (0
.2)
NA
0N
A65
(1.0
)
LIVE
RTo
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X. -
all c
ombi
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clud
ed-
(pm
p)12
8 (1
5.2)
299
(27.
2)6
(0.8
)N
A88
(8.4
)51
(9.1
)8
(6.2
)56
(10.
4)11
64 (1
7.9)
Pae
diat
ric <
15 y
ears
736
0N
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71
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Spl
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(0.2
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(0.6
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(pm
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(pm
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(0.2
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NA
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HE
AR
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all c
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clud
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(pm
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(6.1
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(0.3
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(5.2
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18 (3
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40
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HE
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Pae
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LUN
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all c
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clud
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(pm
p)12
0 (1
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111
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NA
18 (1
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30 (5
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3 (2
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23 (4
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324
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(1.2
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5 (0
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6 (1
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1 (0
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1 (0
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82
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pmp)
113
(13.
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NA
13 (1
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24 (4
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2 (1
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22 (4
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242
(3.7
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m li
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don
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(pm
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-0
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m D
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(dou
ble
+ si
ngle
)(pm
p)-
17 (1
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A0
NA
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A0
PAN
CR
EA
STo
tal T
X. -
all c
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natio
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clud
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(pm
p)16
(1.9
)14
(1.3
)0
NA
32 (3
.0)
--
1 (0
.2)
73 (1
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Pae
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Kid
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pmp)
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11 (1
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TX. f
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mp)
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mal
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mp)
--
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mal
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(pm
p)-
-0
NA
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--
5 (0
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RE
CIP
IEN
TSTo
tal n
umbe
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pat
ient
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lant
ed (p
mp)
--
25 (3
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NA
521
(49.
6)34
4 (6
1.4)
55 (4
2.3)
275
(50.
9)47
55 (7
3.0)
Pae
diat
ric <
15 y
ears
--
0N
A14
-3
-16
3P
atie
nts
tran
spla
nted
fro
m li
ving
don
ors
(pm
p)57
(6.8
)75
(6.8
)12
(1.6
)19
(17.
3)40
(3.8
)10
0 (1
7.9)
4 (3
.1)
13 (2
.4)
316
(4.9
)
`NA
´: N
ot a
pplic
able
34
DO
NAT
ION
AN
D T
RA
NSP
LAN
TATI
ON
AC
TIVI
TY
EUR
OP
EAN
UN
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CO
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TRIE
SC
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GER
MA
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GR
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EH
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GA
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DIT
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BO
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GM
ALT
AP
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n (m
illio
n in
habi
tant
s)U
NFP
A: h
ttp:
//w
ww
.unf
pa.o
rg/p
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560
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23.
30.
50.
4
DO
NAT
ION
Act
ual d
ecea
sed
orga
n do
nors
-bot
h D
BD
and
DC
D in
clud
ed-
(pm
p)12
00 (1
4.7)
79 (6
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131(
13.1
)93
(20.
7)13
25 (2
1.8)
40 (1
8.2)
39 (1
1.8)
9 (1
8.0)
12 (3
0.0)
Act
ual d
onor
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ter
circ
ulat
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deat
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CD
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(0.1
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(5.9
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ultio
rgan
don
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1041
5154
8692
54
168
8
TRA
NSP
LAN
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KID
NE
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X. -
all c
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natio
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clud
ed-
(pm
p)28
50 (3
4.8)
185
(16.
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1 (2
5.1)
192
(43.
1)17
51 (2
8.8)
77 (3
5.0)
75 (2
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(45.
0)%
(TX.
fro
m li
ving
d. /
TX.
fro
m d
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27.9
24.9
18.7
14.1
12.1
14.
00
33.3
Pae
diat
ric <
15 y
ears
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77
653.
90
00
TX. f
rom
dec
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d do
nors
(pm
p)20
55 (2
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139
(12.
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4 (2
0.4)
165
(36.
7)15
40 (2
5.3)
74 (3
3.6)
72 (2
1.8)
012
(30.
0)S
ingl
e TX
. (pm
p)20
20 (2
4.7)
137
(12.
0)20
4 (2
0.4)
162
(36.
0)14
32 (2
3.6)
74 (3
3.6)
72 (2
1.8)
012
(30.
0)D
oubl
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. (pm
p)35
(0.4
)2
(0.2
)0
3 (0
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108
(1.8
)0
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0TX
. fro
m li
ving
don
ors
(pm
p)79
5 (9
.7)
46 (4
.0)
47 (4
.7)
27 (6
.0)
211
(3.5
)3
(1.4
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(0.9
)0
6 (1
5.0)
TX. f
rom
Rel
ated
livi
ng d
onor
s (p
mp)
-46
(4.0
)47
(4.7
)27
(6.0
)13
4 (2
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3 (1
.4)
3 (0
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05
(12.
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. fro
m U
nrel
ated
livi
ng d
onor
s (p
mp)
--
00
77 (1
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1 (2
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TX. f
rom
DC
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mp)
0-
01
(0.2
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(0.0
)26
(11.
8)N
A0
NA
LIVE
RTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)11
99 (1
4.7)
42 (3
.7)
41 (4
.4)
61 (1
3.6)
1034
(17.
0)1
(0.5
)12
(3.6
)0
NA
Pae
diat
ric <
15 y
ears
740
20
660
00
NA
Spl
it TX
. (pm
p)75
(0.9
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1 (0
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068
(1.1
)0
NA
0N
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o TX
. (pm
p)12
(0.1
)-
00
00
NA
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. fro
m li
ving
don
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(pm
p)71
(0.9
)-
00
15 (0
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00
0N
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m D
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(pm
p)0
-0
00
0N
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NA
HE
AR
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tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)36
6 (4
.5)
6 (0
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14 (1
.4)
6 (1
.3)
278
(4.6
)3
(1.4
)5
(1.5
)-
1 (2
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Pae
diat
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15 y
ears
190
10
260
0-
0
HE
AR
T-LU
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Tota
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(pm
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(0.1
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08
(1.8
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(0.0
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0-
NA
Pae
diat
ric <
15 y
ears
0-
00
10
0-
NA
LUN
GTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)33
7 (4
.1)
-N
A8
(1.8
)12
0 (2
.0)
01
(0.3
)-
NA
Pae
diat
ric <
15 y
ears
5-
NA
06
00
-N
AS
ingl
e TX
. (pm
p)57
(0.7
)-
NA
7 (1
.6)
32 (0
.5)
00
-N
AD
oubl
e TX
. (he
art-
lung
TX.
in
clud
ed) (
pmp)
280
(3.4
)-
NA
1 (0
.2)
88 (1
.4)
01
(0.3
)-
NA
TX. f
rom
livi
ng d
onor
s (p
mp)
--
NA
00
0N
A-
NA
TX. f
rom
DC
D (d
oubl
e +
sing
le)(
pmp)
0-
NA
00
0N
A-
NA
PAN
CR
EA
STo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)17
1 (2
.1)
1 (0
.1)
10 (1
.0)
8 (1
.8)
58 (1
.0)
03
(0.9
)-
NA
Pae
diat
ric <
15 y
ears
0-
00
10
0-
NA
Kid
ney
- P
ancr
eas
TX. (
pmp)
154
(1.9
)1
(0.1
)10
(1.0
)7
(1.6
)41
(0.7
)0
3 (0
.9)
-N
AP
ancr
eas
TX. A
lone
(pm
p)14
(0.2
)-
01
(0.2
)14
(0.2
)0
NA
-N
ATX
. fro
m D
CD
(pm
p)0
-0
00
0N
A-
NA
SMA
LL B
OW
EL
Tota
l TX.
-al
l com
bina
tions
incl
uded
- (p
mp)
9 (0
.1)
-N
AN
A4
(0.1
)0
NA
-N
AP
aedi
atric
<15
yea
rs0
-N
AN
A2
0N
A-
NA
Live
r +
Sm
all b
owel
(pm
p)4
(0.0
)-
NA
NA
2 (0
.0)
0N
A-
NA
Sm
all b
owel
TX.
Alo
ne (p
mp)
5 (0
.1)
-N
AN
A2
(0.0
)0
NA
-N
A
RE
CIP
IEN
TSTo
tal n
umbe
r of
pat
ient
s tr
ansp
lant
ed (p
mp)
-23
2 (2
0.4)
304
(30.
4)19
2 (4
2.7)
3167
(52.
1)81
(36.
8)93
(28.
2)-
19 (4
7.5)
Pae
diat
ric <
15 y
ears
-5
134
161
30
-0
Pat
ient
s tr
ansp
lant
ed f
rom
livi
ng d
onor
s (p
mp)
866
(10.
6)46
(4.0
)47
(4.7
)27
(6.0
)22
6 (3
.7)
3 (1
.4)
3 (0
.9)
-6
(15.
0)
`NA
´: N
ot a
pplic
able
35
DO
NAT
ION
AN
D T
RA
NSP
LAN
TATI
ON
AC
TIVI
TY
EUR
OP
EAN
UN
ION
CO
UN
TRIE
SC
OU
NTR
IES
NET
HER
LAN
DS
PO
LAN
DP
OR
TUG
AL
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NIA
SLO
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SPA
INSW
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DO
NAT
ION
Act
ual d
ecea
sed
orga
n do
nors
-bot
h D
BD
and
DC
D in
clud
ed-
(pm
p)22
7 (1
3.6)
553
(14.
4)30
1 (2
8.1)
77 (3
.6)
69 (1
2.5)
31 (1
5.5)
1667
(35.
3)14
6 (1
5.5)
1056
(17.
0)A
ctua
l don
ors
afte
r ci
rcul
ator
y de
ath
–DC
D-
(pm
p)11
7 (7
.0)
00
3 (0
.1)
00
117
(2.5
)0
405
(6.5
)M
ultio
rgan
don
ors
178
323
223
5840
24-
123
749
TRA
NSP
LAN
TATI
ON
KID
NE
YTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)86
0 (5
1.5)
1075
(28.
1)53
0 (4
9.5)
219
(10.
2)12
9 (2
3.5)
46 (2
3.0)
2498
(52.
9)43
5 (4
6.3)
2752
(44.
2)%
(TX.
fro
m li
ving
d. /
TX.
fro
m d
ecea
sed
d.)
51.2
3.7
8.9
34.2
10.1
012
.542
.337
.3P
aedi
atric
<15
yea
rs13
5010
92
063
1594
TX. f
rom
dec
ease
d do
nors
(pm
p)42
0 (2
5.1)
1035
(27.
0)48
3 (4
5.1)
144
(6.7
)11
6 (2
1.1)
46 (2
3.0)
2186
(46.
3)25
1 (2
6.7)
1726
(27.
7)S
ingl
e TX
. (pm
p)41
9 (2
5.1)
-45
5 (4
2.5)
141
(6.6
)11
5 (2
1.0)
46 (2
3.0)
2167
(45.
9)25
0 (2
6.6)
-D
oubl
e TX
. (pm
p)1
(0.0
)-
28 (2
.6)
3 (0
.1)
1 (0
.2)
019
(0.4
)1
(0.1
)-
TX. f
rom
livi
ng d
onor
s (p
mp)
440
(26.
3)40
(1.0
)47
(4.4
)75
(3.5
)13
(2.4
)0
312
(6.6
)18
4 (1
9.6)
1026
(16.
5)TX
. fro
m R
elat
ed li
ving
don
ors
(pm
p)21
7 (1
3.0)
40 (1
.0)
31 (2
.9)
-10
(2.0
)0
304
(6.4
)18
3 (1
9.5)
934
(15.
0)TX
. fro
m U
nrel
ated
livi
ng d
onor
s (p
mp)
223
(13.
4)0
16 (1
.5)
-3
(0.5
)0
8 (0
.2)
1 (0
.1)
92 (1
.5)
TX. f
rom
DC
D (p
mp)
207
(12.
4)0
06
(0.3
)0
014
0 (3
.0)
-62
2 (1
0.0)
LIVE
RTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)13
5 (8
.1)
300
(7.8
)21
9 (2
0.5)
65 (3
.0)
25 (4
.5)
20 (1
0.0)
1137
(24.
1)15
6 (1
6.6)
759
(12.
2)P
aedi
atric
<15
yea
rs21
305
20
068
1410
1S
plit
TX. (
pmp)
1 (0
.1)
00
4 (0
.2)
01
(0.5
)4
(0.1
)-
124
(2.0
)D
omin
o TX
. (pm
p)2
(0.1
)0
26 (2
.4)
00
06
(0.1
)3
(0.3
)4
(0.1
)TX
. fro
m li
ving
don
ors
(pm
p)8
(0.5
)18
(0.5
)0
8 (0
.4)
00
28 (0
.6)
7 (0
.7)
37 (0
.6)
TX. f
rom
DC
D (p
mp)
37 (2
.2)
00
3 (0
.1)
00
8 (0
.2)
-12
4 (2
.0)
HE
AR
TTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)44
(2.6
)80
(2.1
)46
(4.3
)7
(0.3
)19
(3.5
)14
(7.0
)23
7 (5
.0)
52 (5
.5)
148
(2.4
)P
aedi
atric
<15
yea
rs4
43
00
117
336
HE
AR
T-LU
NG
Tota
l TX.
(pm
p)0
00
00
04
(0.1
)1
(0.1
)4
(0.1
)P
aedi
atric
<15
yea
rs0
00
00
00
00
LUN
GTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)68
(4.1
)15
(0.4
)18
(1.7
)0
00
230
(4.9
)60
(6.4
)19
1 (3
.1)
Pae
diat
ric <
15 y
ears
10
00
00
60
2S
ingl
e TX
. (pm
p)13
(0.8
)10
(0.3
)10
(0.9
)0
00
100
(2.1
)15
(1.6
)35
(0.6
)D
oubl
e TX
. (he
art-
lung
TX.
in
clud
ed) (
pmp)
55 (3
.3)
5 (0
.1)
8 (0
.7)
00
013
0 (2
.8)
45 (4
.8)
156
(2.5
)TX
. fro
m li
ving
don
ors
(pm
p)0
00
00
0N
A-
0TX
. fro
m D
CD
(dou
ble
+ si
ngle
)(pm
p)27
(1.6
)0
00
00
8 (0
.2)
-19
(0.3
)
PAN
CR
EA
STo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)30
(1.8
)34
(0.9
)25
(2.3
)0
01
(0.5
)11
1 (2
.4)
35 (3
.7)
236
(3.8
)P
aedi
atric
<15
yea
rs0
00
00
05
-2
Kid
ney
- P
ancr
eas
TX. (
pmp)
20 (1
.2)
33 (0
.9)
25 (2
.3)
00
1 (0
.5)
92 (1
.9)
26 (2
.8)
163
(2.6
)P
ancr
eas
TX. A
lone
(pm
p)2
(0.1
)1
(0.0
)0
00
014
(0.3
)9
(1.0
)35
(0.6
)TX
. fro
m D
CD
(pm
p)4
(0.2
)0
00
00
0-
40 (0
.6)
SMA
LL B
OW
EL
Tota
l TX.
-al
l com
bina
tions
incl
uded
- (p
mp)
1 (0
.1)
00
00
09
(0.2
)2
(0.2
)21
(0.3
)P
aedi
atric
<15
yea
rs0
00
00
07
-8
Live
r +
Sm
all b
owel
(pm
p)0
00
00
00
-9
(0.1
)S
mal
l bow
el T
X. A
lone
(pm
p)1
(0.1
)0
00
00
4 (0
.1)
-12
(0.2
)
RE
CIP
IEN
TSTo
tal n
umbe
r of
pat
ient
s tr
ansp
lant
ed (p
mp)
1122
(67.
2)14
64 (3
8.2)
812
(75.
9)-
-80
(40.
0)40
79 (8
6.4)
711
(75.
6)39
02 (6
2.6)
Pae
diat
ric <
15 y
ears
3984
18-
-1
154
-33
5P
atie
nts
tran
spla
nted
fro
m li
ving
don
ors
(pm
p)44
8 (2
6.8)
58 (1
.5)
47 (4
.4)
83 (3
.9)
13 (2
.4)
034
0 (7
.2)
191
(24.
4)10
63 (1
7.1)
`NA
´: N
ot a
pplic
able
36
DO
NAT
ION
AN
D T
RA
NSP
LAN
TATI
ON
AC
TIVI
TY
OTH
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OU
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CO
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634
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37.
64.
36.
4
DO
NAT
ION
Act
ual d
ecea
sed
orga
n do
nors
-bot
h D
BD
and
DC
D in
clud
ed-
(pm
p)N
A33
7 (1
4.9)
96 (1
0.0)
531
(15.
4)14
8 (3
3.6)
NA
02
(6.7
)82
(10.
8)10
(2.3
)N
AA
ctua
l don
ors
afte
r ci
rcul
ator
y de
ath
–DC
D-
(pm
p)N
A86
(3.8
)0
65 (1
.9)
-N
A0
0-
22 (5
.1)
NA
Mul
tiorg
an d
onor
s N
A24
056
-13
0N
A0
262
8N
A
TRA
NSP
LAN
TATI
ON
KID
NE
YTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)12
4 (3
.4)
825
(36.
5)17
5 (1
8.2)
1236
(35.
8)23
7 (5
3.9)
1417
(17.
2)17
(4.0
)11
(36.
7)24
2 (3
1.8)
80 (1
8.6)
5 (0
.8)
% (T
X. f
rom
livi
ng d
. / T
X. f
rom
dec
ease
d d.
)10
030
.93.
435
.03.
810
010
010
049
.281
.310
0P
aedi
atric
<15
yea
rs12
2321
-4
--
-9
-0
TX. f
rom
dec
ease
d do
nors
(pm
p)0
570
(25.
2)16
9 (1
7.6)
803
(23.
3)22
8 (5
1.8)
NA
0-
123
(16.
2)15
(3.5
)N
AS
ingl
e TX
. (pm
p)0
554
(24.
5)16
9 (1
7.6)
786
(22.
8)22
5 (5
1.1)
NA
0-
-15
(3.5
)N
AD
oubl
e TX
. (pm
p)0
16 (0
.7)
017
(0.5
)3
(0.7
)N
A0
--
0N
ATX
. fro
m li
ving
don
ors
(pm
p)12
4 (3
.4)
255
(11.
3)6
(0.6
)43
3 (1
2.6)
9 (2
.0)
1417
(17.
2)17
(4.0
)11
(36.
7)11
9 (1
5.7)
65 (1
5.1)
5 (0
.8)
TX. f
rom
Rel
ated
livi
ng d
onor
s (p
mp)
118
(3.3
)21
6 (9
.6)
6 (0
.6)
275
(8.0
)-
--
11 (3
6.7)
90 (1
1.8)
-5
(0.8
)TX
. fro
m U
nrel
ated
livi
ng d
onor
s (p
mp)
6 (0
.2)
39 (1
.7)
015
8 (4
.6)
--
-0
29 (3
.8)
-0
TX. f
rom
DC
D (p
mp)
015
1 (6
.7)
010
8 (3
.1)
0N
A0
--
-N
A
LIVE
RTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)6
(0.2
)21
5 (9
.5)
43 (4
.5)
487
(14.
1)12
4 (2
8.2)
450
(5.5
)0
-75
(9.9
)1
(0.2
)0
Pae
diat
ric <
15 y
ears
012
9-
4N
A0
-3
-0
Spl
it TX
. (pm
p)0
30 (1
.3)
016
(0.5
)5
(1.1
)N
A0
-2
(0.3
)-
NA
Dom
ino
TX. (
pmp)
0-
00
0N
A0
--
-N
ATX
. fro
m li
ving
don
ors
(pm
p)6
(0.2
)2
(0.1
)2
(0.2
)64
(1.9
)3
(0.7
)45
0 (5
.5)
0-
6 (0
.8)
-0
TX. f
rom
DC
D (p
mp)
011
(0.5
)0
20 (0
.6)
0N
A0
--
1 (0
.2)
NA
HE
AR
TTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)0
66 (2
.9)
21 (2
.2)
157
(4.6
)38
(8.6
)N
A0
-23
(3.0
)6
(1.4
)N
AP
aedi
atric
<15
yea
rs0
40
01
NA
0-
3-
NA
HE
AR
T-LU
NG
Tota
l TX.
(pm
p)0
2 (0
.1)
01
(0.0
)-
NA
0-
4 (0
.5)
-N
AP
aedi
atric
<15
yea
rs0
-0
0-
NA
0-
2-
NA
LUN
GTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)0
159
(7.0
)0
181
(5.2
)-
NA
0-
59 (7
.8)
-N
AP
aedi
atric
<15
yea
rs0
50
--
NA
0-
2-
NA
Sin
gle
TX. (
pmp)
012
(0.5
)0
13 (0
.4)
-N
A0
-39
(5.1
)-
NA
Dou
ble
TX. (
hear
t-lu
ng T
X.
incl
uded
) (pm
p)0
147
(6.5
)0
167
(4.8
)-
NA
0-
20 (2
.6)
-N
ATX
. fro
m li
ving
don
ors
(pm
p)0
-0
1 (0
.0)
-N
A0
--
-N
ATX
. fro
m D
CD
(dou
ble
+ si
ngle
)(pm
p)0
33 (1
.5)
024
(0.7
)-
NA
0-
--
NA
PAN
CR
EA
STo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)0
26 (1
.2)
2 (0
.2)
108
(3.1
)12
(2.7
)N
A0
-12
(1.6
)-
NA
Pae
diat
ric <
15 y
ears
01
0-
-N
A0
--
-N
AK
idne
y -
Pan
crea
s TX
. (pm
p)0
26 (1
.2)
2 (0
.2)
56 (1
.6)
10 (2
.3)
NA
0-
12 (1
.6)
-N
AP
ancr
eas
TX. A
lone
(pm
p)0
-0
15 (0
.4)
2 (0
.5)
NA
0-
--
NA
TX. f
rom
DC
D (p
mp)
0-
03
(0.1
)-
NA
0-
--
NA
SMA
LL B
OW
EL
Tota
l TX.
-al
l com
bina
tions
incl
uded
- (p
mp)
0-
02
(0.1
)-
NA
0-
--
NA
Pae
diat
ric <
15 y
ears
0-
0-
-N
A0
--
-N
ALi
ver
+ S
mal
l bow
el (p
mp)
0-
00
-N
A0
--
-N
AS
mal
l bow
el T
X. A
lone
(pm
p)0
-0
0-
NA
0-
--
NA
RE
CIP
IEN
TSTo
tal n
umbe
r of
pat
ient
s tr
ansp
lant
ed (p
mp)
130
(3.6
)12
66 (5
6.0)
241
(25.
1)-
-18
67 (2
2.6)
17 (4
.0)
11 (3
6.7)
125
(16.
4)87
(20.
2)5
(0.8
)P
aedi
atric
<15
yea
rs12
-30
--
NA
0-
--
0P
atie
nts
tran
spla
nted
fro
m li
ving
don
ors
(pm
p)13
0 (3
.6)
257
(11.
4)8
(0.8
)49
8 (1
4.4)
12 (2
.7)
1867
(22.
6)17
(4.0
)11
(36.
7)12
5 (1
6.4)
65 (1
5.1)
5 (0
.8)
`NA
´: N
ot a
pplic
able
37
DO
NAT
ION
AN
D T
RA
NSP
LAN
TATI
ON
AC
TIVI
TY
OTH
ER C
OU
NTR
IES
CO
UN
TRIE
SM
ACED
ON
IAM
OLD
OVA
NEW
ZEA
LAN
DN
OR
WAY
PALE
STIN
ER
USS
IASW
ITZE
RLA
ND
SYR
IATU
NIS
IATU
RK
EYU
SAP
opul
atio
n (m
illio
n in
habi
tant
s)U
NFP
A: h
ttp:
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ublic
/2.
13.
64.
45.
04.
214
2.8
8.0
20.8
10.7
74.7
313.
1
DO
NAT
ION
Act
ual d
ecea
sed
orga
n do
nors
-bot
h D
BD
and
DC
D in
clud
ed-
(pm
p)0
035
(8.0
)12
7 (2
4.5)
NA
470
(3.3
)10
0 (1
2.5)
06
(0.6
)31
1 (4
.2)
8126
(26.
0)A
ctua
l don
ors
afte
r ci
rcul
ator
y de
ath
–DC
D-
(pm
p)0
02
(0.5
)0
NA
187
(1.3
)3
(0.4
)0
0N
A10
55 (3
.4)
Mul
tiorg
an d
onor
s 0
031
112
NA
188
870
128
363
60 (2
0.3)
TRA
NSP
LAN
TATI
ON
KID
NE
YTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)6
(2.9
)1
(0.3
)11
8 (2
6.8)
302
(60.
4)49
(11.
7)97
5 (6
.8)
282
(35.
3)36
3 (1
7.5)
109
(10.
2)29
42 (3
9.4)
1761
0 (5
6.2)
% (T
X. f
rom
livi
ng d
. / T
X. f
rom
dec
ease
d d.
)10
010
048
.324
.210
018
.435
.810
089
.982
.332
.8P
aedi
atric
<15
yea
rs2
06
5N
A-
725
318
449
1TX
. fro
m d
ecea
sed
dono
rs (p
mp)
00
61 (1
3.9)
229
(45.
8)N
A79
6 (5
.6)
181
(22.
6)0
11 (1
.0)
521
(7.0
)11
838
(37.
8)S
ingl
e TX
. (pm
p)0
057
(13.
0)22
9 (4
5.8)
NA
796
(5.6
)17
5 (2
1.9)
011
(1.0
)N
A11
536
(36.
8)D
oubl
e TX
. (pm
p)0
04
(1.0
)0
NA
06
(0.8
)0
0N
A30
2 (1
.0)
TX. f
rom
livi
ng d
onor
s (p
mp)
6 (2
.9)
1 (0
.3)
57 (1
3.0)
73 (1
4.6)
49 (1
1.7)
179
(1.3
)10
1 (1
2.6)
363
(17.
5)98
(9.2
)24
21 (3
2.4)
5772
(18.
4)TX
. fro
m R
elat
ed li
ving
don
ors
(pm
p)6
(2.9
)1
(0.3
)49
(11.
1)73
(14.
6)49
(11.
7)17
9 (1
.3)
101
(12.
6)14
1 (6
.8)
98 (9
.2)
NA
5029
(16.
1)TX
. fro
m U
nrel
ated
livi
ng d
onor
s (p
mp)
00
8 (1
.8)
00
NA
022
2 (1
0.7)
0N
A74
3 (2
.4)
TX. f
rom
DC
D (p
mp)
00
4 (0
.9)
-N
A-
6 (0
.8)
00
NA
1723
LIVE
RTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)1
(0.5
)0
30 (6
.8)
89 (1
7.8)
NA
204
(1.4
)10
9 (1
3.6)
00
904
(12.
1)63
42 (2
0.3)
Pae
diat
ric <
15 y
ears
10
35
NA
-11
00
183
491
Spl
it TX
. (pm
p)0
0-
-N
A1
(0.0
)18
(2.3
)0
0N
A14
3 (0
.5)
Dom
ino
TX. (
pmp)
00
-0
NA
NA
00
0N
A11
(0.0
)TX
. fro
m li
ving
don
ors
(pm
p)0
08
(1.8
)0
NA
81 (0
.6)
9 (1
.1)
00
623
(8.3
)24
7 (0
.8)
TX. f
rom
DC
D (p
mp)
00
2 (0
.5)
-N
A1
(0.0
)1
(0.1
)0
0N
A26
9 (0
.9)
HE
AR
TTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)N
AN
A12
(2.7
)30
(6.0
)N
A10
7 (0
.7)
36 (4
.5)
01(
0.1)
93 (1
.2)
2349
(7.5
)P
aedi
atric
<15
yea
rsN
AN
A-
2N
A0
30
013
322
HE
AR
T-LU
NG
Tota
l TX.
(pm
p)N
AN
A-
1 (0
.2)
NA
2 (0
.0)
00
0-
27 (0
.1)
Pae
diat
ric <
15 y
ears
NA
NA
-0
NA
00
00
-1
LUN
GTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)N
AN
A13
(3.0
)28
(5.6
)N
A8
(0.1
)54
(6.8
)0
05
(0.1
)18
49 (5
.9)
Pae
diat
ric <
15 y
ears
NA
NA
-0
NA
00
00
-25
Sin
gle
TX. (
pmp)
NA
NA
-0
NA
06
(0.8
)0
05
(0.1
)54
8 (1
.8)
Dou
ble
TX. (
hear
t-lu
ng T
X.
incl
uded
) (pm
p)N
AN
A13
(3.0
)28
(5.6
)N
A8
(0.1
)48
(6.0
)0
0-
1301
(4.2
)TX
. fro
m li
ving
don
ors
(pm
p)N
AN
A-
-N
A0
00
0-
1 (0
.0)
TX. f
rom
DC
D (d
oubl
e +
sing
le)(
pmp)
NA
NA
--
NA
00
00
NA
19 (0
.1)
PAN
CR
EA
STo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)N
AN
A3
(0.7
)20
(4.0
)N
A14
(0.1
)28
(3.5
)0
026
(0.3
)10
82 (3
.5)
Pae
diat
ric <
15 y
ears
NA
NA
--
NA
00
00
-31
Kid
ney
- P
ancr
eas
TX. (
pmp)
NA
NA
3 (0
.7)
10 (2
.0)
NA
13 (0
.1)
14 (1
.8)
00
-79
5 (2
.5)
Pan
crea
s TX
. Alo
ne (p
mp)
NA
NA
-10
(2.0
)N
A1
(0.0
)12
(1.5
)0
0-
287
(0.9
)TX
. fro
m D
CD
(pm
p)N
AN
A-
-N
A1
(0.0
)0
00
NA
32 (0
.1)
SMA
LL B
OW
EL
Tota
l TX.
-al
l com
bina
tions
incl
uded
- (p
mp)
NA
NA
--
NA
NA
1 (0
.1)
00
1 (0
.0)
129
(0.4
)P
aedi
atric
<15
yea
rsN
AN
A-
-N
AN
A0
00
-51
Live
r +
Sm
all b
owel
(pm
p)N
AN
A-
-N
AN
A0
00
NA
50 (0
.2)
Sm
all b
owel
TX.
Alo
ne (p
mp)
NA
NA
--
NA
NA
00
01
(0.0
)66
(0.2
)
RE
CIP
IEN
TSTo
tal n
umbe
r of
pat
ient
s tr
ansp
lant
ed (p
mp)
6 (2
.9)
1 (0
.3)
115
(26.
1)45
7 (9
1.4)
49 (1
1.7)
1292
(9.0
)49
2 (6
1.5)
363
(17.
5)11
0 (1
0.3)
3928
(52.
6)28
539
(91.
1)P
aedi
atric
<15
yea
rs2
0-
-N
AN
A20
03
557
1406
Pat
ient
s tr
ansp
lant
ed f
rom
livi
ng d
onor
s (p
mp)
6 (2
.9)
1 (0
.3)
65 (1
4.8)
73 (1
4.6)
49 (1
1.7)
260
(1.8
)11
0 (1
3.8)
363
(17.
5)98
(9.2
)30
44 (4
0.7)
6020
(19.
2)
`NA
´: N
ot a
pplic
able
38
DO
NAT
ION
AN
D T
RA
NSP
LAN
TATI
ON
AC
TIVI
TY
LATI
NA
MER
ICA
N C
OU
NTR
IES
CO
UN
TRIE
SA
RG
ENTI
NA
BO
LIVI
AB
RA
SIL
CH
ILE
CO
LOM
BIA
CO
STA
RIC
AC
UB
AD
OM
INIC
AN
AEC
UA
DO
RP
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n (m
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tant
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ublic
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6.7
17.3
46.9
4.7
11.3
10.1
14.7
DO
NAT
ION
Act
ual d
ecea
sed
orga
n do
nors
-bot
h D
BD
and
DC
D in
clud
ed-
(pm
p)60
4 (1
4.9)
10 (1
.0)
2207
(11.
2)11
3 (6
.5)
392
(8.4
)24
(5.1
)12
8 (1
1.3)
17 (1
.7)
31 (2
.2)
Act
ual d
onor
s af
ter
circ
ulat
ory
deat
h –D
CD
- (p
mp)
00
2433
(12.
4)0
0N
A-
00
Mul
tiorg
an d
onor
s 33
00
1125
9011
18
229
31
TRA
NSP
LAN
TATI
ON
KID
NE
YTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)10
97 (2
7.0)
75 (7
.4)
4957
(25.
2)23
9 (1
3.8)
798
(17.
0)14
8 (3
1.5)
146
(12.
9)45
(4.5
)82
(5.6
)%
(TX.
fro
m li
ving
d. /
TX.
fro
m d
ecea
sed
d.)
22.7
74.7
33.1
18.4
8.8
80.4
1.4
51.1
36.6
Pae
diat
ric <
15 y
ears
462
83-
5610
60
11TX
. fro
m d
ecea
sed
dono
rs (p
mp)
848
(20.
9)19
(1.9
)33
14 (1
6.8)
195
(11.
3)72
7 (1
5.5)
29 (6
.2)
144
(12.
7)22
(2.2
)52
(3.5
)S
ingl
e TX
. (pm
p)84
7 (2
0.9)
--
-72
4 (1
5.4)
29 (6
.2)
142
(12.
6)22
(2.2
)52
(3.5
)D
oubl
e TX
. (pm
p)1
(0.0
)-
--
3 (0
.1)
02
(0.2
)0
0TX
. fro
m li
ving
don
ors
(pm
p)24
9 (6
.1)
56 (5
.5)
1643
(8.4
)44
(2.5
)71
(1.5
)11
9 (2
5.3)
2 (0
.2)
23 (2
.3)
30 (2
.0)
TX. f
rom
Rel
ated
livi
ng d
onor
s (p
mp)
249
(6.1
)45
(4.5
)13
45 (6
.8)
44 (2
.5)
65 (1
.4)
119
(25.
3)-
19 (1
.9)
30 (2
.0)
TX. f
rom
Unr
elat
ed li
ving
don
ors
(pm
p)0
11 (1
.1)
298
(1.5
)0
6 (0
.1)
0-
4 (0
.4)
0TX
. fro
m D
CD
(pm
p)0
19 (1
.9)
NA
00
24 (5
.1)
00
0
LIVE
RTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)36
4 (9
.0)
014
96 (7
.6)
90 (5
.2)
191
(4.1
)14
(3.0
)22
(1.9
)9
(0.9
)15
(1.0
)P
aedi
atric
<15
yea
rs22
018
3 (0
.9)
-27
3 (0
.6)
-0
1S
plit
TX. (
pmp)
25 (0
.6)
00
00
-2
(0.2
)0
0D
omin
o TX
. (pm
p)1(
0.0)
00
00
-0
00
TX. f
rom
livi
ng d
onor
s (p
mp)
32 (0
.8)
010
4 (0
.5)
12 (0
.7)
7 (0
.1)
6 (1
.3)
2 (0
.2)
00
TX. f
rom
DC
D (p
mp)
00
NA
00
7 (1
.5)
00
0
HE
AR
TTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)10
6 (2
.6)
016
0 (0
.8)
32 (1
.8)
82 (1
.7)
6 (1
.3)
2 (0
.2)
NA
2 (0
.1)
Pae
diat
ric <
15 y
ears
70
29-
5N
A-
NA
0
HE
AR
T-LU
NG
Tota
l TX.
(pm
p)1
(0.0
)0
00
0N
A2
(0.2
)N
A0
Pae
diat
ric <
15 y
ears
00
00
0N
A-
NA
0
LUN
GTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)26
(0.6
)0
48 (0
.2)
27 (1
.6)
4 (0
.1)
NA
0N
A0
Pae
diat
ric <
15 y
ears
30
4-
0N
A0
NA
0S
ingl
e TX
. (pm
p)13
(0.3
)0
0-
2 (0
.0)
NA
0N
A0
Dou
ble
TX. (
hear
t-lu
ng T
X.
incl
uded
) (pm
p)13
(0.3
)0
0-
2 (0
.0)
NA
0N
A0
TX. f
rom
livi
ng d
onor
s (p
mp)
00
1 (0
.0)
00
NA
0N
A0
TX. f
rom
DC
D (d
oubl
e +
sing
le)(
pmp)
00
NA
00
NA
0N
A0
PAN
CR
EA
STo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)75
(1.8
)0
184
(0.9
)1
(0.1
)6
(0.1
)N
A0
NA
0P
aedi
atric
<15
yea
rs0
01
-0
NA
0N
A0
Kid
ney
- P
ancr
eas
TX. (
pmp)
65 (1
.6)
013
0 (0
.7)
1 (0
.1)
4 (0
.1)
NA
0N
A0
Pan
crea
s TX
. Alo
ne (p
mp)
9 (0
.2)
054
(0.3
)0
2 (0
.0)
NA
0N
A0
TX. f
rom
DC
D (p
mp)
00
NA
00
NA
0N
A0
SMA
LL B
OW
EL
Tota
l TX.
-al
l com
bina
tions
incl
uded
- (p
mp)
5 (0
.1)
0N
A0
3 (0
.1)
NA
0N
A0
Pae
diat
ric <
15 y
ears
30
NA
00
NA
0N
A0
Live
r +
Sm
all b
owel
(pm
p)1
(0.0
)0
NA
01
(0.0
)-
0N
A0
Sm
all b
owel
TX.
Alo
ne (p
mp)
4 (0
.1)
0N
A0
2 (0
.0)
-0
NA
0
RE
CIP
IEN
TSTo
tal n
umbe
r of
pat
ient
s tr
ansp
lant
ed (p
mp)
1377
(33.
9)-
6485
(34.
8)38
9 (2
2.5)
1084
(23.
1)16
8 (3
5.7)
-54
(5.3
)97
(24.
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aedi
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<15
yea
rs81
2 30
0-
8813
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tran
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fro
m li
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don
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(pm
p)28
1 (6
.9)
56 (5
.5)
1748
(8.9
)56
(3.2
)78
(1.7
)12
5 (2
6.6)
4 (0
.4)
23 (2
.3)
30 (2
4.4)
`NA
´: N
ot a
pplic
able
39
DO
NAT
ION
AN
D T
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TATI
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4.8
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Act
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and
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(pm
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356
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clud
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(pm
p)44
(7.1
)10
2 (6
.9)
2468
(21.
5)-
64 (1
8.8)
14 (2
.1)
213
(7.2
)13
2 (3
8.8)
298
(10.
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(TX.
fro
m li
ving
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TX.
fro
m d
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100
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aedi
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. fro
m d
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sed
dono
rs (p
mp)
016
(1.1
)57
9 (5
.0)
-48
(14.
1)0
180
(6.1
)12
8 (3
7.6)
205
(7.0
)S
ingl
e TX
. (pm
p)0
16 (1
.1)
571
(5.0
)-
-0
176
(6.0
)-
205
(7.0
)D
oubl
e TX
. (pm
p)0
08
(0.1
)-
-0
4 (0
.1)
NA
0TX
. fro
m li
ving
don
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(pm
p)44
(7.1
)86
(5.8
)18
89 (1
6.5)
-16
(4.7
)14
(2.1
)33
(1.1
)4
(1.2
)93
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. fro
m R
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ving
don
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(pm
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(5.4
)15
38 (1
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-13
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(1.2
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. fro
m U
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00
0-
0-
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all c
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ns in
clud
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(pm
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A10
0 (0
.9)
-6
(1.8
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38 (1
.3)
24 (7
.1)
8 (0
.3)
Pae
diat
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15 y
ears
NA
NA
20-
-0
31
3S
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pmp)
NA
NA
--
00
0N
A0
Dom
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TX. (
pmp)
NA
NA
0-
-0
0N
A0
TX. f
rom
livi
ng d
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s (p
mp)
NA
NA
5 (0
.0)
-0
02
(0.1
)N
A8
(0.3
)TX
. fro
m D
CD
(pm
p)N
AN
A0
--
00
NA
0
HE
AR
TTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)N
AN
A19
(0.2
)-
NA
08
(0.3
)8
(2.4
)0
Pae
diat
ric <
15 y
ears
NA
NA
1-
NA
01
10
HE
AR
T-LU
NG
Tota
l TX.
(pm
p)N
AN
A0
-N
A0
00
0P
aedi
atric
<15
yea
rsN
AN
A0
-N
A0
00
0
LUN
GTo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)N
AN
A0
-N
A0
4 (0
.1)
1 (0
.3)
0P
aedi
atric
<15
yea
rsN
AN
A0
-N
A0
00
0S
ingl
e TX
. (pm
p)N
AN
A0
-N
A0
4 (0
.1)
1 (0
.3)
0D
oubl
e TX
. (he
art-
lung
TX.
in
clud
ed) (
pmp)
NA
NA
0-
NA
00
00
TX. f
rom
livi
ng d
onor
s (p
mp)
NA
NA
0-
NA
00
00
TX. f
rom
DC
D (d
oubl
e +
sing
le)(
pmp)
NA
NA
0-
NA
00
NA
0
PAN
CR
EA
STo
tal T
X. -
all c
ombi
natio
ns in
clud
ed-
(pm
p)N
AN
A0
-N
A-
05
(1.5
)0
Pae
diat
ric <
15 y
ears
NA
NA
0-
NA
-0
00
Kid
ney
- P
ancr
eas
TX. (
pmp)
NA
NA
0-
NA
-0
5 (1
.5)
0P
ancr
eas
TX. A
lone
(pm
p)N
AN
A0
-N
A-
0N
A0
TX. f
rom
DC
D (p
mp)
NA
NA
0-
NA
-0
NA
0
SMA
LL B
OW
EL
Tota
l TX.
-al
l com
bina
tions
incl
uded
- (p
mp)
NA
NA
1 (0
.0)
-N
A-
00
0P
aedi
atric
<15
yea
rsN
AN
A0
-N
A-
00
0Li
ver
+ S
mal
l bow
el (p
mp)
NA
NA
0-
NA
-0
00
Sm
all b
owel
TX.
Alo
ne (p
mp)
NA
NA
1 (0
.0)
-N
A-
00
0
RE
CIP
IEN
TSTo
tal n
umbe
r of
pat
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s tr
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44 (7
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102
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-N
A14
(2.1
)26
3 (8
.9)
168
(49.
4)30
6 (1
0.4)
Pae
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ric <
15 y
ears
010
24
6 -
NA
-28
617
Pat
ient
s tr
ansp
lant
ed f
rom
livi
ng d
onor
s (p
mp)
44 (7
.1)
86 (5
.8)
1894
(16.
5)-
16 (4
.7)
14 (2
.1)
35 (1
.2)
4 (1
.2)
101
(3.4
)
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ot a
pplic
able
40
WA
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EUR
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NFP
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ttp:
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411
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KID
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CEN
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--
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11
44
Pat
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s in
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L fo
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st t
ime
in t
he c
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e of
201
1
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500
133
1136
127
939
207
3884
Tota
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of p
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nts
ever
act
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on t
he W
L du
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2011
--
969
5310
4261
610
347
412
320
Pat
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s aw
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tran
spla
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activ
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ndid
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) on
31/1
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1174
388
395
041
667
322
4329
289
42
Pat
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s w
ho d
ied
whi
le o
n th
e W
L du
ring
2011
4535
2-
2528
413
200
Pat
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s on
dia
lyse
s on
31/
12/2
011
--
-37
3-
-32
2-
NA
LIVE
RN
º TX
CEN
TRES
--
2N
A2
11
123
Pat
ient
s in
clud
ed o
n th
e W
L fo
r th
e fir
st t
ime
in t
he c
ours
e of
201
1
162
337
19N
A10
557
1263
1530
Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
ring
2011
--
50N
A16
289
1371
2462
Pat
ient
s aw
aitin
g fo
r a
tran
spla
nt (o
nly
activ
e ca
ndid
ates
) on
31/1
2/20
1111
217
227
NA
4326
611
941
Pat
ient
s w
ho d
ied
whi
le o
n th
e W
L du
ring
2011
3654
4N
A12
41
113
5
HE
AR
TN
º TX
CEN
TRES
--
2N
A2
2-
126
Pat
ient
s in
clud
ed o
n th
e W
L fo
r th
e fir
st t
ime
in t
he c
ours
e of
201
1
5610
69
NA
8436
-29
514
Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
ring
2011
--
40N
A17
153
-49
798
Pat
ient
s aw
aitin
g fo
r a
tran
spla
nt (o
nly
activ
e ca
ndid
ates
) on
31/1
2/20
1167
5928
NA
8416
-22
302
Pat
ient
s w
ho d
ied
whi
le o
n th
e W
L du
ring
2011
923
1N
A11
5-
460
LUN
GN
º TX
CEN
TRES
--
0N
A1
11
113
Pat
ient
s in
clud
ed o
n th
e W
L fo
r th
e fir
st t
ime
in t
he c
ours
e of
201
1
135
142
0N
A29
282
2532
5
Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
ring
2011
--
0N
A67
715
3414
5
Pat
ient
s aw
aitin
g fo
r a
tran
spla
nt (o
nly
activ
e ca
ndid
ates
) on
31/1
2/20
1166
119
NA
3026
28
17
Pat
ient
s w
ho d
ied
whi
le o
n th
e W
L du
ring
2011
208
0N
A18
9-
248
9
PAN
CR
EA
SN
º TX
CEN
TRES
--
0N
A1
0-
116
Pat
ient
s in
clud
ed o
n th
e W
L fo
r th
e fir
st t
ime
in t
he c
ours
e of
201
1
1537
0N
A29
--
492
Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
ring
2011
--
0N
A85
--
424
0
Pat
ient
s aw
aitin
g fo
r a
tran
spla
nt (o
nly
activ
e ca
ndid
ates
) on
31/1
2/20
1117
510
NA
45-
-3
144
Pat
ient
s w
ho d
ied
whi
le o
n th
e W
L du
ring
2011
31
0N
A4
--
05
SMA
LL B
OW
EL
Nº
TX C
ENTR
ES-
-0
NA
1-
-1
6
Pat
ient
s in
clud
ed o
n th
e W
L fo
r th
e fir
st t
ime
in t
he c
ours
e of
201
1
--
0N
A0
--
-11
Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
ring
2011
--
0N
A1
--
-23
Pat
ient
s aw
aitin
g fo
r a
tran
spla
nt (o
nly
activ
e ca
ndid
ates
) on
31/1
2/20
11-
-0
NA
1-
--
12
Pat
ient
s w
ho d
ied
whi
le o
n th
e W
L du
ring
2011
--
0N
A0
--
-1
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WA
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EUR
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Pop
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(mill
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inha
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UN
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: htt
p://
ww
w.u
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/pub
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81.8
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Pat
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s in
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L fo
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st t
ime
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ours
e of
201
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408
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Tota
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atie
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ever
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he W
L du
ring
2011
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1352
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5218
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80
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Pat
ient
s aw
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ates
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Pat
ient
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whi
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e W
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2011
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Pat
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0417
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CEN
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241
11
220
20
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Pat
ient
s in
clud
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e W
L fo
r th
e fir
st t
ime
in t
he c
ours
e of
201
1
1792
9110
863
1101
045
0N
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Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
ring
2011
-15
319
283
2272
079
0N
A
Pat
ient
s aw
aitin
g fo
r a
tran
spla
nt (o
nly
activ
e ca
ndid
ates
) on
31/1
2/20
1121
1994
128
2010
000
550
NA
Pat
ient
s w
ho d
ied
whi
le o
n th
e W
L du
ring
2011
-17
1910
162
011
0N
A
HE
AR
TN
º TX
CEN
TRES
221
21
191
20
1
Pat
ient
s in
clud
ed o
n th
e W
L fo
r th
e fir
st t
ime
in t
he c
ours
e of
201
1
695
1723
943
25
110
NA
Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
ring
2011
-44
3816
1143
929
0N
A
Pat
ient
s aw
aitin
g fo
r a
tran
spla
nt (o
nly
activ
e ca
ndid
ates
) on
31/1
2/20
1110
3930
1317
733
318
0N
A
Pat
ient
s w
ho d
ied
whi
le o
n th
e W
L du
ring
2011
-3
50
940
70
NA
LUN
GN
º TX
CEN
TRES
14-
01
130
10
0
Pat
ient
s in
clud
ed o
n th
e W
L fo
r th
e fir
st t
ime
in t
he c
ours
e of
201
1
435
-11
2521
80
10
NA
Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
ring
2011
--
2038
561
03
0N
A
Pat
ient
s aw
aitin
g fo
r a
tran
spla
nt (o
nly
activ
e ca
ndid
ates
) on
31/1
2/20
1160
6-
736
382
02
0N
A
Pat
ient
s w
ho d
ied
whi
le o
n th
e W
L du
ring
2011
--
010
570
00
NA
PAN
CR
EA
SN
º TX
CEN
TRES
23-
21
130
10
0
Pat
ient
s in
clud
ed o
n th
e W
L fo
r th
e fir
st t
ime
in t
he c
ours
e of
201
1
188
-11
966
05
0N
A
Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
ring
2011
--
3118
306
025
0N
A
Pat
ient
s aw
aitin
g fo
r a
tran
spla
nt (o
nly
activ
e ca
ndid
ates
) on
31/1
2/20
1128
2-
21-
236
018
0N
A
Pat
ient
s w
ho d
ied
whi
le o
n th
e W
L du
ring
2011
--
30
30
00
NA
SMA
LL B
OW
EL
Nº
TX C
ENTR
ES4
--
NA
30
NA
00
Pat
ient
s in
clud
ed o
n th
e W
L fo
r th
e fir
st t
ime
in t
he c
ours
e of
201
1
15-
-N
A4
0N
A0
NA
Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
ring
2011
--
-N
A29
0N
A0
NA
Pat
ient
s aw
aitin
g fo
r a
tran
spla
nt (o
nly
activ
e ca
ndid
ates
) on
31/1
2/20
1112
--
NA
230
NA
0N
A
Pat
ient
s w
ho d
ied
whi
le o
n th
e W
L du
ring
2011
--
-N
A2
0N
A0
NA
42
WA
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Pat
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Pat
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Pat
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Pat
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Tota
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2011
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2172
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1330
Pat
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31/1
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1064
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Pat
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2011
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Pat
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2330
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138
Tota
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2011
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Pat
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252
1711
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1917
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Pat
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2011
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23
LUN
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Pat
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120
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560
145
Tota
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on t
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2011
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Pat
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Pat
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Pat
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2535
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Tota
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Pat
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Pat
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Pat
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Tota
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Pat
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Pat
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Tota
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Pat
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Pat
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Pat
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267
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160
NA
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457
20
Tota
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2011
NA
437
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204
11-
Pat
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376
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511
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Pat
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2011
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9718
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HE
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CEN
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111
-N
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Pat
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1
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9711
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NA
--
346
NA
Tota
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nts
ever
act
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on t
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2011
NA
139
63-
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162
7N
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Pat
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521
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--
967
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Pat
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whi
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2011
NA
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Pat
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in t
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201
1
NA
172
16-
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-N
A
Tota
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of p
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nts
ever
act
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on t
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L du
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2011
NA
288
16-
-N
A-
-79
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A
Pat
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31/1
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11N
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1627
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--
70-
NA
Pat
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s w
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whi
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2011
NA
13N
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A-
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-N
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PAN
CR
EA
SN
º TX
CEN
TRES
02
18
-N
A-
-7
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A
Pat
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s in
clud
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L fo
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in t
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1
NA
402
--
NA
--
2-
NA
Tota
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on t
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2011
NA
7617
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Pat
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NA
Pat
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whi
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2011
NA
30
161
NA
--
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NA
--
--
NA
Pat
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s in
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in t
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201
1
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10
--
NA
--
--
NA
Tota
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2011
NA
30
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NA
Pat
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Pat
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2011
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10
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Pat
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NA
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Tota
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2011
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565
Pat
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Pat
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2011
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Pat
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133
Pat
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L fo
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ime
in t
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ours
e of
201
1
NA
0N
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181
NA
NA
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Tota
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of p
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ever
act
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on t
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L du
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2011
NA
0N
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90
-28
9N
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A27
3324
160
Pat
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tran
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activ
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) on
31/1
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11N
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019
Pat
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whi
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2011
NA
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0-
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01
11
NA
93
01
1312
9
Pat
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in t
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e of
201
1
NA
0N
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NA
-57
NA
NA
-33
05
Tota
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of p
atie
nts
ever
act
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on t
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L du
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2011
NA
0N
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NA
-88
NA
NA
387
5675
Pat
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s aw
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tran
spla
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) on
31/1
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11N
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NA
-36
-N
A21
822
14
Pat
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s w
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whi
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L du
ring
2011
NA
-N
A3
NA
-9
NA
NA
4433
1
LUN
GN
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CEN
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00
11
NA
32
01
364
Pat
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in t
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201
1
NA
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NA
-54
NA
NA
-23
11
Tota
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ber
of p
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ever
act
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on t
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2011
NA
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NA
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NA
1437
73
Pat
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31/1
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-49
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NA
413
33
Pat
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whi
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2011
NA
-N
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NA
-5
NA
NA
324
0
PAN
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00
11
NA
33
00
511
2
Pat
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201
1
NA
-N
A27
NA
-35
NA
NA
-54
6
Tota
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of p
atie
nts
ever
act
ive
on t
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L du
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2011
NA
-N
A31
NA
-84
-N
A19
396
4
Pat
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activ
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31/1
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11N
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45
NA
-51
NA
NA
6933
6
Pat
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s w
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whi
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2011
NA
-N
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NA
-0
NA
NA
1444
SMA
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24
Pat
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s in
clud
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in t
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e of
201
1
NA
-N
A-
NA
-2
NA
NA
-17
7
Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
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2011
NA
-N
A-
NA
-3
-N
A-
379
Pat
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tran
spla
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activ
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) on
31/1
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0-
NA
-2
NA
NA
-18
4
Pat
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s w
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whi
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2011
NA
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NA
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NA
NA
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Pat
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Tota
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of p
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ever
act
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on t
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2011
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1931
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9986
Pat
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31/1
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1948
611
8510
0117
050
0-
34
Pat
ient
s w
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ied
whi
le o
n th
e W
L du
ring
2011
337
125
1-
2523
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0
Pat
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s on
dia
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620
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019
550
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240
528
63
31
1
Pat
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s in
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e W
L fo
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st t
ime
in t
he c
ours
e of
201
1
681
013
0733
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186
-
Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
ring
2011
1207
031
6715
5-
4432
1330
Pat
ient
s aw
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g fo
r a
tran
spla
nt (o
nly
activ
e ca
ndid
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) on
31/1
2/20
1173
80
1138
155
5026
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9
Pat
ient
s w
ho d
ied
whi
le o
n th
e W
L du
ring
2011
116
020
2-
815
51
6
HE
AR
TN
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TRES
280
447
71
1N
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Pat
ient
s in
clud
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e W
L fo
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ime
in t
he c
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e of
201
1
151
018
310
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4N
A-
Tota
l num
ber
of p
atie
nts
ever
act
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on t
he W
L du
ring
2011
262
026
59
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Pat
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s aw
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tran
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activ
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) on
31/1
2/20
1187
020
19
125
4N
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Pat
ient
s w
ho d
ied
whi
le o
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e W
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ring
2011
470
183
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32
NA
1
LUN
GN
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CEN
TRES
120
54
10
0N
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Pat
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s in
clud
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e W
L fo
r th
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in t
he c
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201
1
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5412
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0N
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Tota
l num
ber
of p
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nts
ever
act
ive
on t
he W
L du
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2011
193
019
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0N
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Pat
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tran
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activ
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31/1
2/20
1113
20
144
308
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NA
0
Pat
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s w
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whi
le o
n th
e W
L du
ring
2011
310
54-
1-
0N
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PAN
CR
EA
SN
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CEN
TRES
110
162
41
2N
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Pat
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s in
clud
ed o
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e W
L fo
r th
e fir
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in t
he c
ours
e of
201
1
113
016
1-
20
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0
Tota
l num
ber
of p
atie
nts
ever
act
ive
on t
he W
L du
ring
2011
111
010
32
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Pat
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g fo
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tran
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activ
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) on
31/1
2/20
1110
50
212
42
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Pat
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s w
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whi
le o
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L du
ring
2011
130
0-
01
0N
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SMA
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0
Pat
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s in
clud
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he c
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e of
201
1
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--
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A0
Tota
l num
ber
of p
atie
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ever
act
ive
on t
he W
L du
ring
2011
170
00
--
0N
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Pat
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s aw
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r a
tran
spla
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nly
activ
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) on
31/1
2/20
118
00
02
-0
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0
Pat
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s w
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whi
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ring
2011
10
00
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A0
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Pat
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201
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540
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Tota
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2011
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1068
Pat
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Pat
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2011
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Pat
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3700
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1643
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11
Pat
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201
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Tota
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ever
act
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on t
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2011
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6-
6-
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9
Pat
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31/1
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11-
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92-
6-
1627
7
Pat
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2011
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21
Pat
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201
1
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180
Tota
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of p
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act
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2011
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400
Pat
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tran
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31/1
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NA
21-
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024
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Pat
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2011
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Pat
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Tota
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2011
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Pat
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11-
NA
2-
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02
NA
Pat
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2011
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--
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PAN
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Pat
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201
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150
Tota
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2011
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Pat
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Pat
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2011
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Pat
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50
International Data on Tissue andHematopoietic Stem Cell Donation and
Transplantation Activity.Year 2011
Data recorded & prepared by: EUROCET - European Network of Competent Authorities for Tissues and Cells -Team (www.eurocet.org)
DATA PROVIDED BY NATIONAL COMPETENT AUTHORITIES:
52
AUSTRIABELGIUMBULGARIAJordan Peev CYPRUSCarolina StylianouCZECH REPUBLICPavel B ezovskýEva K emenováDENMARKJohanna StrobelRalf R. TönjesESTONIAPille HarrisonEliisa LukkFINLANDFRANCEArnaud De GuerraGERMANYJohanna StrobelRalf R. TönjesGREECESofia MaleskouHUNGARYTokar LillaIRELANDITALYFiorenza BarianiLetizia LombardiniLATVIAAnita DaugavvanagaLITHUANIADainora MedeisieneLUXEMBURGMALTANETHERLANDSPOLANDArtur KaminskiAgnieszka A. KrawczykPORTUGALMargarida Amil Diaz Catarina Bolotinha
ROMANIARosana TurcuAndrei NicaSLOVAKIAJan Koller SLOVENIASPAINBibiana RamosMarina AlvarezRosario MarazuelaSWEDENHelena StrömMona HanssonUNITED KINGDOM Liz McAnulty Imogen SwannAmy Gelsthorpe-HillCROATIAVanja NikolacKristina StankoviSandra TomljenoviICELANDMACEDONIAMOLDOVAIgor CodreanuTatiana TimbalariNORWAYVibeke DalenChristine Fjeldstad NulandSWITZERLANDTURKEYHalil Yılmaz SURNuran Erden
ARGENTINACarlos SorattiMartín Alejandro TorresRicardo Rubén IbarBOLIVIAOlker Calla RivadeneiraBRASILHeder Murari BorbaCHILEJose Luis RojasCOLOMBIAJuan Gonzalo López CasasDiana Carolina Plazas SierraCOSTA RICAMarvin Agüero Chinchilla César A. Gamboa PeñarandaCUBAAngela Olga Hidalgo SánchezDOMINICANAFernando Morales BilliniECUADORDiana AlmeidaMEXICOLuis Antonio Meixueiro DazaOmar Sánchez RamírezNICARAGUATulio René Mendieta AlonsoPANAMACesar Cuero ZambranoPARAGUAYHugo A. Espinoza C.PERUJuan A. Almeyda AlcántaraURUGUAYInés AlvarezRaul José MizrajiVENEZUELACarmen Luisa Lattuf de MilanésZoraida Pacheco Graterol
Preliminary European Figures on Tissue & Cell (HPC) Donation andTransplantation Activities, documents produced by the “EUROCET - European
Network of Competent Authorities for Tissues and Cells” (2011)
PR
ELIM
INA
RY
DAT
A O
N T
ISSU
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EUR
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FIN
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Po
pu
lati
on
(F
on
t: e
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sta
t)8.4
04.2
52
10.9
51.2
66
7.3
69.4
31
839.7
51
10.4
85.4
89
5.5
52.0
37
1.3
40.1
94
5.3
75.2
76
65.0
48.4
12
TY
PE
OF
TIS
SU
ET
YP
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F D
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NO
DATA
NO
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NO
DATA
NO
DATA
CO
RN
EA
N.
of
tiss
ue d
onatio
ns
66
0405
31
5.0
25
Tis
sue d
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MP
8,9
60,0
038,6
223,1
377,2
5N
° o
f t
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etr
ieve
d125
0806
34
9.9
98
N°
tiss
ue p
rocess
ed
(units)
125
NO
DATA
658
34
9.9
98
N°
tiss
ue d
istr
ibute
d (
units)
89
NO
DATA
479
34
3.8
46
N°
tiss
ue i
mp
ort
ed
(units)
016
00
0N
° tiss
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00
68
0133
N°
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d89
16
479
34
3.3
49
N°
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nsp
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dN
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16
479
34
NO
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N°
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89
16
479
34
3.3
49
SK
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149
050
NO
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189
Tis
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n P
MP
20,2
20,0
04,7
7N
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2,9
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° o
f t
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ieve
d (
cm
2)
NO
DATA
0122.1
04
NO
DATA
347.0
41
N°
tiss
ue p
rocess
ed
(units)
NO
DATA
NO
DATA
NO
DATA
NO
DATA
347.0
41
N°
tiss
ue d
istr
ibute
d (
units)
NO
DATA
NO
DATA
NO
DATA
NO
DATA
309.5
55
N°
tiss
ue i
mp
ort
ed
(units)
00
0N
O D
ATA
39.5
00
N°
tiss
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rted
(units)
00
1.0
20
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0N
° o
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lante
d64
00
NO
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NO
DATA
N°
of
patients
tra
nsp
lante
dN
O D
ATA
00
NO
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NO
DATA
N°
of
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lants
64
00
NO
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NO
DATA
CA
RD
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TIS
SU
EN
. o
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00
61
NO
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165
Tis
sue d
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n P
MP
0,0
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05,8
2N
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2,5
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dN
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0104
NO
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361
N°
tiss
ue p
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ed
(units)
0N
O D
ATA
104
NO
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361
N°
tiss
ue d
istr
ibute
d (
units)
0N
O D
ATA
64
NO
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200
N°
tiss
ue i
mp
ort
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(units)
00
0N
O D
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72
N°
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ue e
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rted
(units)
00
8N
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0N
° o
f tiss
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064
NO
DATA
NO
DATA
N°
of
patients
tra
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lante
d0
064
NO
DATA
NO
DATA
N°
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transp
lants
00
64
NO
DATA
NO
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BLO
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VE
SS
EL
N.
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00
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7276
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78
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40
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00
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28
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d0
07
10
NO
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N°
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33
NO
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N°
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00
734
NO
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MU
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N.
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138
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18,7
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N°
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0676
63
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N°
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84
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113
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PLA
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19
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2,5
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69
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NO
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81
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90
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tiss
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54
77
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00
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N°
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N°
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77
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NO
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NO
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NO
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N°
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NO
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NO
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NO
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NO
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N°
tiss
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10
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00
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N°
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53
PR
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DAT
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EUR
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109
115
N°
of p
atie
nts
tran
spla
nted
197
NO
DAT
A10
911
3N
° of
tra
nsp
lant
s15
46.
797
218
115
PLA
CE
NTA
/AM
NIO
TIC
ME
MB
RA
NE
N.
of t
issu
e d
onat
ions
117
616
10Ti
ssue
don
atio
n P
MP
0,10
2,90
7,71
3,08
N°
of
tissu
e re
trie
ved
017
616
9N
° tis
sue
pro
cess
ed (
units
)22
081
045
N°
tissu
e d
istr
ibut
ed (
units
)90
13.1
550
73N
° tis
sue
imp
orte
d (
units
)0
00
0N
° tis
sue
exp
orte
d (
units
)0
00
0N
° of
tis
sues
tra
nsp
lant
ed18
NO
DAT
A0
73N
° of
pat
ient
s tr
ansp
lant
ed18
NO
DAT
A0
57N
° of
tra
nsp
lant
s32
1.10
40
73
OTH
ER
SN
. of
tis
sue
don
atio
ns1
00
0Ti
ssue
don
atio
n P
MP
0,10
0,00
0,00
0,00
N°
of
tissu
e re
trie
ved
00
00
N°
tissu
e p
roce
ssed
(un
its)
20N
O D
ATA
00
N°
tissu
e d
istr
ibut
ed (
units
)5
NO
DAT
A0
0N
° tis
sue
imp
orte
d (
units
)0
00
0N
° tis
sue
exp
orte
d (
units
)0
00
0N
° of
tis
sues
tra
nsp
lant
ed32
NO
DAT
A0
0N
° of
pat
ient
s tr
ansp
lant
ed32
NO
DAT
A0
0N
° of
tra
nsp
lant
s32
NO
DAT
A0
0
54
PR
ELIM
INA
RY
DAT
A O
N T
ISSU
ES -
YEA
R 2
011
EUR
OP
EAN
UN
ION
CO
UN
TRIE
S C
oun
try
NE
TH
ER
LAN
DS
PO
LAN
DP
OR
TU
GA
LR
OM
AN
IAS
LOVA
KIA
SLO
VE
NIA
SPA
INS
WE
DE
NU
. K
.P
opul
atio
n (F
ont:
eur
osta
t)16
.655
.799
38.2
00.0
3710
.572
.157
21.4
13.8
155.
392.
446
2.05
0.18
946
.152
.926
9.41
5.57
062
.498
.610
TYP
E O
F TI
SS
UE
TYP
E O
F D
ATA
NO
DAT
AN
O D
ATA
CO
RN
EA
N.
of t
issu
e d
onat
ions
652
506
4412
82.
772
434
NO
DAT
ATi
ssue
don
atio
n P
MP
17,0
747
,86
2,05
23,7
460
,06
46,0
9N
O D
ATA
N°
of
tissu
e re
trie
ved
1.29
498
744
101
4.21
888
210
.556
N°
tissu
e p
roce
ssed
(un
its)
1.17
7N
O D
ATA
444.
218
890
10.2
82N
° tis
sue
dis
trib
uted
(un
its)
905
752
4315
12.
622
630
3.89
4N
° tis
sue
imp
orte
d (
units
)0
162
840
10
159
N°
tissu
e ex
por
ted
(un
its)
00
00
10
159
N°
of t
issu
es t
rans
pla
nted
NO
DAT
A91
612
715
12.
705
NO
DAT
AN
O D
ATA
N°
of p
atie
nts
tran
spla
nted
NO
DAT
AN
O D
ATA
127
151
2.88
7N
O D
ATA
NO
DAT
AN
° of
tra
nsp
lant
sN
O D
ATA
916
127
0N
O D
ATA
630
NO
DAT
A
SK
INN
. of
tis
sue
don
atio
ns30
113
.675
2120
740
NO
DAT
ATi
ssue
don
atio
n P
MP
13,6
40,
0963
8,61
3,89
4,50
4,28
NO
DAT
AN
° of
tis
sue
retr
ieve
d (
cm2)
86.9
0084
313
.675
109.
378
567.
256
NO
DAT
A1.
364
N°
tissu
e p
roce
ssed
(un
its)
86.5
0084
413
.675
no d
ata
567.
256
461.
247
N°
tissu
e d
istr
ibut
ed (
units
)99
20
12.3
0020
212
cm2
320.
055
93.9
994.
284
N°
tissu
e im
por
ted
(un
its)
01
00
0N
O D
ATA
2.17
4N
° tis
sue
exp
orte
d (
units
)0
00
076
02.
174
N°
of t
issu
es t
rans
pla
nted
NO
DAT
A5.
000
12.3
0020
212
cm2
205.
920
NO
DAT
AN
O D
ATA
N°
of p
atie
nts
tran
spla
nted
NO
DAT
A3
62
45N
O D
ATA
NO
DAT
AN
° of
tra
nsp
lant
sN
O D
ATA
311
NO
DAT
A19
NO
DAT
A
CA
RD
IAC
TIS
SU
EN
. of
tis
sue
don
atio
ns24
717
020
198
243
NO
DAT
ATi
ssue
don
atio
n P
MP
6,47
1,61
0,00
3,71
4,29
25,8
1N
O D
ATA
N°
of
tissu
e re
trie
ved
494
340
3032
824
31.
048
N°
tissu
e p
roce
ssed
(un
its)
330
180
3032
824
31.
038
N°
tissu
e d
istr
ibut
ed (
units
)21
27
013
134
145
469
N°
tissu
e im
por
ted
(un
its)
00
00
00
23N
° tis
sue
exp
orte
d (
units
)0
00
067
050
N°
of t
issu
es t
rans
pla
nted
NO
DAT
A7
013
142
NO
DAT
AN
O D
ATA
N°
of p
atie
nts
tran
spla
nted
NO
DAT
A7
013
64N
O D
ATA
NO
DAT
AN
° of
tra
nsp
lant
sN
O D
ATA
70
13N
O D
ATA
148
NO
DAT
A
BLO
OD
VE
SS
EL
N.
of t
issu
e d
onat
ions
121
00
204
94N
O D
ATA
Tiss
ue d
onat
ion
PM
P0,
310,
090,
000,
004,
429,
98N
O D
ATA
N°
of
tissu
e re
trie
ved
151
0N
O D
ATA
391
9428
5N
° tis
sue
pro
cess
ed (
units
)15
00
NO
DAT
A39
111
773
N°
tissu
e d
istr
ibut
ed (
units
)15
00
NO
DAT
A22
015
50N
° tis
sue
imp
orte
d (
units
)0
00
NO
DAT
A0
09
N°
tissu
e ex
por
ted
(un
its)
00
0N
O D
ATA
2120
9N
° of
tis
sues
tra
nsp
lant
edN
O D
ATA
00
NO
DAT
A17
3N
O D
ATA
NO
DAT
AN
° of
pat
ient
s tr
ansp
lant
edN
O D
ATA
00
NO
DAT
A15
615
NO
DAT
AN
° of
tra
nsp
lant
sN
O D
ATA
00
NO
DAT
AN
O D
ATA
15N
O D
ATA
MU
SC
ULO
SK
ELE
TAL
N.
of t
issu
e d
onat
ions
721
5919
771
82.
072
1.73
3N
O D
ATA
Tiss
ue d
onat
ion
PM
P18
,87
5,58
9,20
133,
1544
,89
184,
06N
O D
ATA
N°
of
tissu
e re
trie
ved
3.28
0N
O D
ATA
197
8.97
613
.883
1.73
310
.459
N°
tissu
e p
roce
ssed
(un
its)
2.71
523
536
51.
024
13.8
831.
764
4.40
3N
° tis
sue
dis
trib
uted
(un
its)
10.6
7527
683
550
10.5
351.
321
19.0
41N
° tis
sue
imp
orte
d (
units
)0
118
230
01.
943
339.
851
N°
tissu
e ex
por
ted
(un
its)
00
07.
952
468
09.
890
N°
of t
issu
es t
rans
pla
nted
NO
DAT
AN
O D
ATA
317
550
9.50
6N
O D
ATA
NO
DAT
AN
° of
pat
ient
s tr
ansp
lant
edN
O D
ATA
NO
DAT
A29
127
88.
675
NO
DAT
AN
O D
ATA
N°
of t
rans
pla
nts
NO
DAT
AN
O D
ATA
291
NO
DAT
A1.
321
NO
DAT
A
PLA
CE
NTA
/AM
NIO
TIC
ME
MB
RA
NE
N.
of t
issu
e d
onat
ions
8258
05
506
NO
DAT
ATi
ssue
don
atio
n P
MP
NO
DAT
A5,
490,
000,
931,
080,
64N
O D
ATA
N°
of
tissu
e re
trie
ved
8259
05
1.56
535
149
N°
tissu
e p
roce
ssed
(un
its)
7231
.496
015
31.
565
351
19N
° tis
sue
dis
trib
uted
(un
its)
524
21.7
260
120
1.65
633
254
8N
° tis
sue
imp
orte
d (
units
)0
00
00
010
N°
tissu
e ex
por
ted
(un
its)
00
00
00
10N
° of
tis
sues
tra
nsp
lant
edN
O D
ATA
188
012
01.
080
NO
DAT
AN
O D
ATA
N°
of p
atie
nts
tran
spla
nted
NO
DAT
AN
O D
ATA
011
11.
275
NO
DAT
AN
O D
ATA
N°
of t
rans
pla
nts
NO
DAT
AN
O D
ATA
0N
O D
ATA
332
NO
DAT
A
OTH
ER
SN
. of
tis
sue
don
atio
ns0
1.94
5N
O D
ATA
NO
DAT
A0
NO
DAT
ATi
ssue
don
atio
n P
MP
0,00
90,8
3N
O D
ATA
NO
DAT
A0,
00N
O D
ATA
N°
of
tissu
e re
trie
ved
01.
945
NO
DAT
AN
O D
ATA
02.
878
N°
tissu
e p
roce
ssed
(un
its)
NO
DAT
A1.
945
NO
DAT
AN
O D
ATA
NO
DAT
A1.
924
N°
tissu
e d
istr
ibut
ed (
units
)N
O D
ATA
0N
O D
ATA
NO
DAT
AN
O D
ATA
631
N°
tissu
e im
por
ted
(un
its)
210
NO
DAT
A0
019
7N
° tis
sue
exp
orte
d (
units
)0
0N
O D
ATA
00
197
N°
of t
issu
es t
rans
pla
nted
160
NO
DAT
AN
O D
ATA
NO
DAT
AN
O D
ATA
N°
of p
atie
nts
tran
spla
nted
NO
DAT
A0
NO
DAT
AN
O D
ATA
NO
DAT
AN
O D
ATA
N°
of t
rans
pla
nts
NO
DAT
A0
NO
DAT
AN
O D
ATA
NO
DAT
AN
O D
ATA
55
PR
ELIM
INA
RY
DAT
A O
N T
ISSU
ES -
YEA
R 2
011
OTH
ER C
OU
NTR
IES
Co
untr
yC
RO
AT
IAIC
ELA
ND
MA
CE
DO
NIA
MO
LDO
VAN
OR
WA
Y
SW
ITZ
ER
LAN
DT
UR
KE
Y
Po
pul
atio
n (F
ont
: eu
rost
at)
4.41
2.13
731
8.45
22.
057.
284
4.92
0.30
57.
870.
134
73.7
22.9
88
TYP
E O
F TI
SS
UE
TYP
E O
F D
ATA
NO
DAT
AN
O D
ATA
NO
DAT
A
CO
RN
EA
N.
of t
issu
e d
onat
ions
120
021
68Ti
ssue
don
atio
n P
MP
2,72
0,00
29,4
1N
° of
tis
sue
retr
ieve
d12
00
2168
N°
tissu
e p
roce
ssed
(un
its)
NO
DAT
A0
NO
DAT
A21
68N
° tis
sue
dis
trib
uted
(un
its)
NO
DAT
A0
019
97N
° tis
sue
imp
orte
d (
units
)67
00
NO
DAT
AN
° tis
sue
exp
orte
d (
units
)0
00
NO
DAT
AN
° of
tis
sues
tra
nsp
lant
ed10
0N
O D
ATA
NO
DAT
AN
° of
pat
ient
s tr
ansp
lant
ed77
0N
O D
ATA
NO
DAT
AN
° of
tra
nsp
lant
s77
0N
O D
ATA
1997
SK
INN
. of
tis
sue
don
atio
ns12
10
2Ti
ssue
don
atio
n P
MP
2,72
0,00
0,03
N°
of
tissu
e re
trie
ved
(cm
2)92
1.00
00
0N
° tis
sue
pro
cess
ed (
units
)16
.416
0N
O D
ATA
NO
DAT
AN
° tis
sue
dis
trib
uted
(un
its)
14.8
960
0N
O D
ATA
N°
tissu
e im
por
ted
(un
its)
00
0N
O D
ATA
N°
tissu
e ex
por
ted
(un
its)
00
0N
O D
ATA
N°
of t
issu
es t
rans
pla
nted
196
1N
O D
ATA
NO
DAT
AN
° of
pat
ient
s tr
ansp
lant
ed4
1N
O D
ATA
NO
DAT
AN
° of
tra
nsp
lant
s8
1N
O D
ATA
2
CA
RD
IAC
TIS
SU
EN
. of
tis
sue
don
atio
ns10
00
1Ti
ssue
don
atio
n P
MP
2,27
0,00
0,01
N°
of
tissu
e re
trie
ved
140
00
N°
tissu
e p
roce
ssed
(un
its)
140
NO
DAT
AN
O D
ATA
N°
tissu
e d
istr
ibut
ed (
units
)N
O D
ATA
00
NO
DAT
AN
° tis
sue
imp
orte
d (
units
)0
00
NO
DAT
AN
° tis
sue
exp
orte
d (
units
)0
00
NO
DAT
AN
° of
tis
sues
tra
nsp
lant
ed0
0N
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ATA
NO
DAT
AN
° of
pat
ient
s tr
ansp
lant
edN
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ATA
0N
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ATA
NO
DAT
AN
° of
tra
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lant
sN
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ATA
0N
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ATA
1
BLO
OD
VE
SS
EL
N.
of t
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onat
ions
00
00
Tiss
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PM
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000,
000,
00N
° of
tis
sue
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ieve
d0
00
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pro
cess
ed (
units
)N
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ATA
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ATA
NO
DAT
AN
° tis
sue
dis
trib
uted
(un
its)
NO
DAT
A0
0N
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ATA
N°
tissu
e im
por
ted
(un
its)
00
0N
O D
ATA
N°
tissu
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por
ted
(un
its)
00
0N
O D
ATA
N°
of t
issu
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rans
pla
nted
NO
DAT
A0
NO
DAT
AN
O D
ATA
N°
of p
atie
nts
tran
spla
nted
NO
DAT
A0
NO
DAT
AN
O D
ATA
N°
of t
rans
pla
nts
NO
DAT
A0
NO
DAT
AN
O D
ATA
MU
SC
ULO
SK
ELE
TAL
N.
of t
issu
e d
onat
ions
230
2637
99
Tiss
ue d
onat
ion
PM
P52
,13
77,0
30,
12N
° of
tis
sue
retr
ieve
d23
026
379
9N
° tis
sue
pro
cess
ed (
units
)15
615
337
9N
O D
ATA
N°
tissu
e d
istr
ibut
ed (
units
)17
018
026
5N
O D
ATA
N°
tissu
e im
por
ted
(un
its)
00
43N
O D
ATA
N°
tissu
e ex
por
ted
(un
its)
00
0N
O D
ATA
N°
of t
issu
es t
rans
pla
nted
126
180
NO
DAT
AN
O D
ATA
N°
of p
atie
nts
tran
spla
nted
167
116
NO
DAT
AN
O D
ATA
N°
of t
rans
pla
nts
166
116
265
9
PLA
CE
NTA
/AM
NIO
TIC
ME
MB
RA
NE
N.
of t
issu
e d
onat
ions
60
00
Tiss
ue d
onat
ion
PM
P1,
360,
000,
00N
° of
tis
sue
retr
ieve
d6
00
0N
° tis
sue
pro
cess
ed (
units
)1.
818
0N
O D
ATA
0N
° tis
sue
dis
trib
uted
(un
its)
510
NO
DAT
A0
N°
tissu
e im
por
ted
(un
its)
00
12N
O D
ATA
N°
tissu
e ex
por
ted
(un
its)
00
0N
O D
ATA
N°
of t
issu
es t
rans
pla
nted
30
NO
DAT
AN
O D
ATA
N°
of p
atie
nts
tran
spla
nted
80
NO
DAT
AN
O D
ATA
N°
of t
rans
pla
nts
120
10N
O D
ATA
OTH
ER
SN
. of
tis
sue
don
atio
ns0
20
1Ti
ssue
don
atio
n P
MP
0,00
0,00
0,01
N°
of
tissu
e re
trie
ved
02
01
N°
tissu
e p
roce
ssed
(un
its)
NO
DAT
A4
NO
DAT
A0
N°
tissu
e d
istr
ibut
ed (
units
)N
O D
ATA
0N
O D
ATA
0N
° tis
sue
imp
orte
d (
units
)0
00
NO
DAT
AN
° tis
sue
exp
orte
d (
units
)0
00
NO
DAT
AN
° of
tis
sues
tra
nsp
lant
edN
O D
ATA
0N
O D
ATA
NO
DAT
AN
° of
pat
ient
s tr
ansp
lant
edN
O D
ATA
0N
O D
ATA
NO
DAT
AN
° of
tra
nsp
lant
sN
O D
ATA
06
1
56
PR
ELIM
INA
RY
DAT
A O
N T
ISSU
ES -
YEA
R 2
011
LATI
NA
MER
ICA
N C
OU
NTR
IES
Co
untr
yA
RG
EN
TIN
AB
OLI
VIA
BR
AS
ILC
HIL
EC
OLO
MB
IAC
OS
TA R
ICA
CU
BA
DO
MIN
ICA
NA
Pop
ulat
ion
(Fon
t: U
NFP
A)
40,6
10,1
196,
717
,346
,94,
711
,310
,1
TYP
E O
F TI
SS
UE
TYP
E O
F D
ATA
CO
RN
EA
N.
of t
issu
e d
onat
ions
772
014
002
441.
181
110
590
17Ti
ssue
don
atio
n P
MP
19,0
00,
0071
,18
2,5
25,1
823
,40
52,2
11,
68N
° of
tis
sue
retr
ieve
dN
° tis
sue
pro
cess
ed (
units
)1.
544
024
200
2.00
621
811
46N
° tis
sue
dis
trib
uted
(un
its)
0N
° tis
sue
imp
orte
d (
units
)N
° tis
sue
exp
orte
d (
units
)N
° of
tis
sues
tra
nsp
lant
edN
° of
pat
ient
s tr
ansp
lant
ed97
20
1517
52.
013
173
588
N°
of t
rans
pla
nts
SK
INN
. of
tis
sue
don
atio
ns14
027
447
16Ti
ssue
don
atio
n P
MP
0,34
0,00
0,14
0,2
1,00
3,40
N°
of
tissu
e re
trie
ved
(cm
2)N
° tis
sue
pro
cess
ed (
units
)0
38.1
9847
13.2
39N
° tis
sue
dis
trib
uted
(un
its)
11.6
620
N°
tissu
e im
por
ted
(un
its)
N°
tissu
e ex
por
ted
(un
its)
N°
of t
issu
es t
rans
pla
nted
55N
° of
pat
ient
s tr
ansp
lant
ed0
1617
427
N°
of t
rans
pla
nts
CA
RD
IAC
TIS
SU
EN
. of
tis
sue
don
atio
ns25
40
539
13Ti
ssue
don
atio
n P
MP
6,26
0,00
0,3
0,83
2,77
N°
of
tissu
e re
trie
ved
N°
tissu
e p
roce
ssed
(un
its)
344
069
26N
° tis
sue
dis
trib
uted
(un
its)
146
0N
° tis
sue
imp
orte
d (
units
)N
° tis
sue
exp
orte
d (
units
)N
° of
tis
sues
tra
nsp
lant
edN
° of
pat
ient
s tr
ansp
lant
ed21
10
887
N°
of t
rans
pla
nts
BLO
OD
VE
SS
EL
N.
of t
issu
e d
onat
ions
10
00
13Ti
ssue
don
atio
n P
MP
0,02
0,00
0,00
2,77
N°
of
tissu
e re
trie
ved
N°
tissu
e p
roce
ssed
(un
its)
40
039
N°
tissu
e d
istr
ibut
ed (
units
)4
00
N°
tissu
e im
por
ted
(un
its)
N°
tissu
e ex
por
ted
(un
its)
N°
of t
issu
es t
rans
pla
nted
N°
of p
atie
nts
tran
spla
nted
40
08
N°
of t
rans
pla
nts
MU
SC
ULO
SK
ELE
TAL
N.
of t
issu
e d
onat
ions
1.44
20
596
724
515
1Ti
ssue
don
atio
n P
MP
35,5
20,
003,
030,
45,
2213
,36
N°
of
tissu
e re
trie
ved
N°
tissu
e p
roce
ssed
(un
its)
1.78
10
999
3.58
81.
005
N°
tissu
e d
istr
ibut
ed (
units
)12
.276
0N
° tis
sue
imp
orte
d (
units
)N
° tis
sue
exp
orte
d (
units
)N
° of
tis
sues
tra
nsp
lant
edN
° of
pat
ient
s tr
ansp
lant
ed8.
036
024
.661
17.7
7132
2N
° of
tra
nsp
lant
s
PLA
CE
NTA
/AM
NIO
TIC
ME
MB
RA
NE
N.
of t
issu
e d
onat
ions
Tiss
ue d
onat
ion
PM
PN
° of
tis
sue
retr
ieve
dN
° tis
sue
pro
cess
ed (
units
)N
° tis
sue
dis
trib
uted
(un
its)
N°
tissu
e im
por
ted
(un
its)
N°
tissu
e ex
por
ted
(un
its)
N°
of t
issu
es t
rans
pla
nted
N°
of p
atie
nts
tran
spla
nted
N°
of t
rans
pla
nts
OTH
ER
SN
. of
tis
sue
don
atio
nsN
O D
ATA
0Ti
ssue
don
atio
n P
MP
0,00
N°
of
tissu
e re
trie
ved
N°
tissu
e p
roce
ssed
(un
its)
NO
DAT
A0
N°
tissu
e d
istr
ibut
ed (
units
)N
O D
ATA
0N
° tis
sue
imp
orte
d (
units
)N
° tis
sue
exp
orte
d (
units
)N
° of
tis
sues
tra
nsp
lant
edN
° of
pat
ient
s tr
ansp
lant
edN
O D
ATA
0N
° of
tra
nsp
lant
s
57
PR
ELIM
INA
RY
DAT
A O
N T
ISSU
ES -
YEA
R 2
011
LATI
NA
MER
ICA
N C
OU
NTR
IES
Co
untr
yE
CU
AD
OR
ME
XIC
ON
ICA
RA
GU
APA
NA
MA
PAR
AG
UA
YP
ER
UU
RU
GU
AY
VE
NE
ZU
ELA
Po
pul
atio
n (F
ont
: U
NFP
A)
14,7
114,
85,
93,
46,
629
,43,
429
,4
TYP
E O
F TI
SS
UE
TYP
E O
F D
ATA
NO
DAT
A
CO
RN
EA
N.
of t
issu
e d
onat
ions
181.
118
113
3011
211
074
Tiss
ue d
onat
ion
PM
P1,
229,
7433
,24
4,55
3,81
32,3
52,
52N
° of
tis
sue
retr
ieve
dN
° tis
sue
pro
cess
ed (
units
)36
942
226
220
143
N°
tissu
e d
istr
ibut
ed (
units
)N
° tis
sue
imp
orte
d (
units
)N
° tis
sue
exp
orte
d (
units
)N
° of
tis
sues
tra
nsp
lant
edN
° of
pat
ient
s tr
ansp
lant
ed1.
753
130
6032
417
113
8N
° of
tra
nsp
lant
s
SK
INN
. of
tis
sue
don
atio
ns5
015
Tiss
ue d
onat
ion
PM
P0,
040,
004,
41N
° of
tis
sue
retr
ieve
d (
cm2)
N°
tissu
e p
roce
ssed
(un
its)
021
.300
N°
tissu
e d
istr
ibut
ed (
units
)0
N°
tissu
e im
por
ted
(un
its)
N°
tissu
e ex
por
ted
(un
its)
N°
of t
issu
es t
rans
pla
nted
N°
of p
atie
nts
tran
spla
nted
011
N°
of t
rans
pla
nts
CA
RD
IAC
TIS
SU
EN
. of
tis
sue
don
atio
ns3
117
Tiss
ue d
onat
ion
PM
P0,
030,
290,
58N
° of
tis
sue
retr
ieve
dN
° tis
sue
pro
cess
ed (
units
)0
135
N°
tissu
e d
istr
ibut
ed (
units
)0
3N
° tis
sue
imp
orte
d (
units
)N
° tis
sue
exp
orte
d (
units
)N
° of
tis
sues
tra
nsp
lant
edN
° of
pat
ient
s tr
ansp
lant
ed0
36
N°
of t
rans
pla
nts
BLO
OD
VE
SS
EL
N.
of t
issu
e d
onat
ions
016
Tiss
ue d
onat
ion
PM
P0,
004,
71N
° of
tis
sue
retr
ieve
dN
° tis
sue
pro
cess
ed (
units
)0
33N
° tis
sue
dis
trib
uted
(un
its)
0N
° tis
sue
imp
orte
d (
units
)N
° tis
sue
exp
orte
d (
units
)N
° of
tis
sues
tra
nsp
lant
edN
° of
pat
ient
s tr
ansp
lant
ed0
15N
° of
tra
nsp
lant
s
MU
SC
ULO
SK
ELE
TAL
N.
of t
issu
e d
onat
ions
9121
Tiss
ue d
onat
ion
PM
P0,
796,
18N
° of
tis
sue
retr
ieve
dN
° tis
sue
pro
cess
ed (
units
)38
N°
tissu
e d
istr
ibut
ed (
units
)N
° tis
sue
imp
orte
d (
units
)N
° tis
sue
exp
orte
d (
units
)N
° of
tis
sues
tra
nsp
lant
edN
° of
pat
ient
s tr
ansp
lant
ed17
8N
° of
tra
nsp
lant
s
PLA
CE
NTA
/AM
NIO
TIC
ME
MB
RA
NE
N.
of t
issu
e d
onat
ions
Tiss
ue d
onat
ion
PM
PN
° of
tis
sue
retr
ieve
dN
° tis
sue
pro
cess
ed (
units
)N
° tis
sue
dis
trib
uted
(un
its)
N°
tissu
e im
por
ted
(un
its)
N°
tissu
e ex
por
ted
(un
its)
N°
of t
issu
es t
rans
pla
nted
N°
of p
atie
nts
tran
spla
nted
N°
of t
rans
pla
nts
OTH
ER
SN
. of
tis
sue
don
atio
ns9
00
Tiss
ue d
onat
ion
PM
P0,
610,
000,
00N
° of
tis
sue
retr
ieve
dN
° tis
sue
pro
cess
ed (
units
)0
0N
° tis
sue
dis
trib
uted
(un
its)
00
N°
tissu
e im
por
ted
(un
its)
N°
tissu
e ex
por
ted
(un
its)
N°
of t
issu
es t
rans
pla
nted
N°
of p
atie
nts
tran
spla
nted
00
N°
of t
rans
pla
nts
58
PR
ELIM
INA
RY
DAT
A O
N H
PC
CEL
LS -
YEA
R 2
011
EUR
OP
EAN
UN
ION
CO
UN
TRIE
S
Cou
ntry
AU
STR
IAB
ELG
IUM
BU
LGA
RIA
CY
PR
US
CZE
CH
R.
DEN
MA
RK
ESTO
NIA
FIN
LAN
DFR
AN
CE
Pop
ulat
ion
(Fon
t: eu
rost
at)
8.40
4.25
210
.951
.266
7.36
9.43
183
9.75
110
.485
.489
5.55
2.03
71.
340.
194
5.37
5.27
665
.048
.412
CAT
EGO
RY
OF
DAT
ATY
PE
OF
DAT
AN
O D
ATA
NO
DAT
AN
O D
ATA
NO
DAT
A
PO
TEN
TIA
L D
ON
ATIO
NA
ND
SEA
RC
HIN
G IN
TH
EN
ATIO
NA
L R
EGIS
TRIE
SN
° of
pot
entia
l don
ors
at 3
1.12
1512
0.54
279
.072
019
6.39
1
N°
of c
oord
blo
od u
nit
at 3
1.12
NO
DAT
A1.
742
3.73
90
16.1
62
N°
of s
earc
hes
requ
este
dN
O D
ATA
2.09
218
.355
019
.490
N°
of u
nrel
ated
don
atio
nN
O D
ATA
2111
50
1.32
5
DO
NAT
ION
N°
of d
onat
ion
- A
utol
ogou
s10
828
035
3.21
8
N°
of d
onat
ion
- A
lloge
nic
737
461
1.66
4
N°
of d
onat
ion
- A
lloge
nic,
rel
ated
715
01
747
N°
of d
onat
ion
- A
lloge
nic,
unr
elat
ed0
2246
091
7
BA
NK
ING
of
CO
RD
BLO
OD
N°
of u
nrel
ated
coo
rd b
lood
uni
ts c
olle
cted
NO
DAT
A1.
289
00
5.44
1
N°
of u
nrel
ated
coo
rd b
lood
uni
ts d
istr
ibut
edN
O D
ATA
00
016
3
N°
of u
nrel
ated
coo
rd b
lood
uni
ts a
t 31
.12
NO
DAT
A1.
712
00
16.1
62
N°
of r
elat
ed c
oord
blo
od u
nits
col
lect
edN
O D
ATA
1.96
10
260
N°
of r
elat
ed c
oord
blo
od u
nits
dis
trib
uted
NO
DAT
A0
0N
A0
N°
of r
elat
ed c
oord
blo
od u
nits
at
31.1
2N
O D
ATA
15.4
990
NA
0
Tota
l N°
of c
oord
blo
od u
nits
col
lect
edN
O D
ATA
3.25
00
NA
5.44
1
Tota
l N°
of c
oord
blo
od u
nits
dis
trib
uted
NO
DAT
A0
0N
A16
3
Tota
l N°
of c
oord
blo
od u
nits
at
31.1
2N
O D
ATA
17.2
110
NA
16.1
62
TRA
NS
PLA
NT
N°
of t
rans
plan
ts -
A
utol
ogou
s79
180
NA
3.00
3
N°
of p
atie
nts
tran
spla
nted
-
Aut
olog
ous
7718
031
0
N°
of t
rans
plan
ts -
A
lloge
nic
110
55N
A1.
769
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c11
010
160
N°
of t
rans
plan
ts -
A
lloge
nic,
rel
ated
80
0N
A74
8
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c, r
elat
ed8
00
10
N°
of t
rans
plan
ts -
A
lloge
nic,
unr
elat
ed3
055
NA
1.02
1
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c, u
nrel
ated
30
1015
0
59
PR
ELIM
INA
RY
DAT
A O
N H
PC
CEL
LS -
YEA
R 2
011
EUR
OP
EAN
UN
ION
CO
UN
TRIE
S
Cou
ntry
GER
MA
NY
GR
EEC
EH
UN
GA
RY
IREL
AN
DIT
ALY
LATV
IALI
THU
AN
IALU
XEM
BO
UR
GM
ALT
A
Pop
ulat
ion
(Fon
t: eu
rost
at)
81.7
51.6
0211
.309
.885
9.98
5.72
24.
480.
858
60.6
26.4
422.
074.
605
3.24
4.60
151
1.84
041
7.61
7
CAT
EGO
RY
OF
DAT
ATY
PE
OF
DAT
AN
O D
ATA
NO
DAT
AN
O D
ATA
NO
DAT
A
PO
TEN
TIA
L D
ON
ATIO
NA
ND
SEA
RC
HIN
G IN
TH
EN
ATIO
NA
L R
EGIS
TRIE
SN
° of
pot
entia
l don
ors
at 3
1.12
NO
DAT
A33
.737
1.24
033
4.77
26.
592
0
N°
of c
oord
blo
od u
nit
at 3
1.12
NO
DAT
A1.
176
1.25
226
.698
765
0
N°
of s
earc
hes
requ
este
dN
O D
ATA
191
03.
594
144
0
N°
of u
nrel
ated
don
atio
nN
O D
ATA
790
735
390
DO
NAT
ION
N°
of d
onat
ion
- A
utol
ogou
s13
.384
NO
DAT
A1.
318
5.08
228
411
7
N°
of d
onat
ion
- A
lloge
nic
10.9
170
01.
219
670
N°
of d
onat
ion
- A
lloge
nic,
rel
ated
1.11
00
093
524
0
N°
of d
onat
ion
- A
lloge
nic,
unr
elat
ed9.
807
00
283
430
BA
NK
ING
of
CO
RD
BLO
OD
N°
of u
nrel
ated
coo
rd b
lood
uni
ts c
olle
cted
2.74
20
021
.820
00
N°
of u
nrel
ated
coo
rd b
lood
uni
ts d
istr
ibut
ed35
00
960
0
N°
of u
nrel
ated
coo
rd b
lood
uni
ts a
t 31
.12
NO
DAT
A1.
176
034
.836
00
N°
of r
elat
ed c
oord
blo
od u
nits
col
lect
ed20
079
7333
921
30
N°
of r
elat
ed c
oord
blo
od u
nits
dis
trib
uted
60
18
00
N°
of r
elat
ed c
oord
blo
od u
nits
at
31.1
2N
O D
ATA
036
722
2.50
371
80
Tota
l N°
of c
oord
blo
od u
nits
col
lect
ed2.
762
079
7322
.159
213
0
Tota
l N°
of c
oord
blo
od u
nits
dis
trib
uted
410
110
40
0
Tota
l N°
of c
oord
blo
od u
nits
at
31.1
2N
O D
ATA
1.17
636
722
37.3
3971
80
TRA
NS
PLA
NT
N°
of t
rans
plan
ts -
A
utol
ogou
s3.
893
NO
DAT
A79
3.00
279
0
N°
of p
atie
nts
tran
spla
nted
-
Aut
olog
ous
3.31
90
792.
377
710
N°
of t
rans
plan
ts -
A
lloge
nic
3.09
897
101.
690
670
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c2.
928
010
1.56
464
0
N°
of t
rans
plan
ts -
A
lloge
nic,
rel
ated
962
01
935
240
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c, r
elat
ed87
20
184
521
0
N°
of t
rans
plan
ts -
A
lloge
nic,
unr
elat
ed2.
136
979
755
430
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c, u
nrel
ated
2.05
60
971
943
0
60
PR
ELIM
INA
RY
DAT
A O
N H
PC
CEL
LS -
YEA
R 2
011
EUR
OP
EAN
UN
ION
CO
UN
TRIE
S
Cou
ntry
NET
HER
LAN
DS
POLA
ND
POR
TUG
ALR
OM
ANIA
SLO
VAK
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OVE
NIA
SPAI
NSW
EDEN
U. K
.
Pop
ulat
ion
(Fon
t: eu
rost
at)
16.6
55.7
9938
.200
.037
10.5
72.1
5721
.413
.815
5.39
2.44
62.
050.
189
46.1
52.9
269.
415.
570
62.4
98.6
10
CAT
EGO
RY
OF
DAT
ATY
PE
OF
DAT
AN
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ATA
NO
DAT
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ATA
PO
TEN
TIA
L D
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ATIO
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SEA
RC
HIN
G IN
TH
EN
ATIO
NA
L R
EGIS
TRIE
SN
° of
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entia
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ors
at 3
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262.
041
277.
938
NO
DAT
A93
.366
NO
DAT
AN
O D
ATA
N°
of c
oord
blo
od u
nit
at 3
1.12
632
7.25
93.
222
52.3
77N
O D
ATA
NO
DAT
A
N°
of s
earc
hes
requ
este
d90
2*2.
808
02.
349
NO
DAT
AN
O D
ATA
N°
of u
nrel
ated
don
atio
n13
814
70
733
NO
DAT
AN
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ATA
DO
NAT
ION
N°
of d
onat
ion
- A
utol
ogou
sN
O D
ATA
395
2.02
91.
675
502
NO
DAT
A
N°
of d
onat
ion
- A
lloge
nic
282
207
1.60
91.
250
98N
O D
ATA
N°
of d
onat
ion
- A
lloge
nic,
rel
ated
144
781.
609
510
NO
DAT
AN
O D
ATA
N°
of d
onat
ion
- A
lloge
nic,
unr
elat
ed13
812
90
740
NO
DAT
AN
O D
ATA
BA
NK
ING
of
CO
RD
BLO
OD
N°
of u
nrel
ated
coo
rd b
lood
uni
ts c
olle
cted
464
10.9
500
5.86
11.
240
7.86
9
N°
of u
nrel
ated
coo
rd b
lood
uni
ts d
istr
ibut
ed0
50
392
6N
O D
ATA
N°
of u
nrel
ated
coo
rd b
lood
uni
ts a
t 31
.12
997
7.26
422
52.7
932.
933
NO
DAT
A
N°
of r
elat
ed c
oord
blo
od u
nits
col
lect
ed5.
823
11.9
7617
.549
30
18.5
01
N°
of r
elat
ed c
oord
blo
od u
nits
dis
trib
uted
42
03
0N
O D
ATA
N°
of r
elat
ed c
oord
blo
od u
nits
at
31.1
236
.527
58.1
7767
.625
00
NO
DAT
A
Tota
l N°
of c
oord
blo
od u
nits
col
lect
ed6.
287
22.9
2617
.549
5.86
41.
240
26.3
70
Tota
l N°
of c
oord
blo
od u
nits
dis
trib
uted
47
039
56
NO
DAT
A
Tota
l N°
of c
oord
blo
od u
nits
at
31.1
237
.524
65.4
4167
.647
52.7
932.
933
NO
DAT
A
TRA
NS
PLA
NT
N°
of t
rans
plan
ts -
A
utol
ogou
sN
O D
ATA
327
01.
675
NO
DAT
AN
O D
ATA
N°
of p
atie
nts
tran
spla
nted
-
Aut
olog
ous
NO
DAT
A31
60
039
7N
O D
ATA
N°
of t
rans
plan
ts -
A
lloge
nic
377
134
099
7N
O D
ATA
NO
DAT
A
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c34
912
60
025
9N
O D
ATA
N°
of t
rans
plan
ts -
A
lloge
nic,
rel
ated
144
680
510
NO
DAT
AN
O D
ATA
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c, r
elat
ed13
563
00
NO
DAT
AN
O D
ATA
N°
of t
rans
plan
ts -
A
lloge
nic,
unr
elat
ed23
366
048
7N
O D
ATA
NO
DAT
A
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c, u
nrel
ated
214
630
0N
O D
ATA
NO
DAT
A
61
PR
ELIM
INA
RY
DAT
A O
N H
PC
CEL
LS -
YEA
R 2
011
OTH
ER C
OU
NTR
IES
Cou
ntry
CR
OAT
IAIC
ELA
ND
MA
CED
ON
IAM
OLD
OVA
NO
RW
AYSW
ITZE
RLA
ND
TUR
KEY
Pop
ulat
ion
(Fon
t: eu
rost
at)
4.41
2.13
731
8.45
22.
057.
284
4.92
0.30
57.
870.
134
73.7
22.9
88
CAT
EGO
RY
OF
DAT
ATY
PE
OF
DAT
AN
O D
ATA
NO
DAT
AN
O D
ATA
PO
TEN
TIA
L D
ON
ATIO
NA
ND
SEA
RC
HIN
G IN
TH
EN
ATIO
NA
L R
EGIS
TRIE
SN
° of
pot
entia
l don
ors
at 3
1.12
26.7
870
33.1
80N
O D
ATA
N°
of c
oord
blo
od u
nit
at 3
1.12
1.56
10
40N
O D
ATA
N°
of s
earc
hes
requ
este
d26
50
6.79
2N
O D
ATA
N°
of u
nrel
ated
don
atio
n21
025
21.
032
DO
NAT
ION
N°
of d
onat
ion
- A
utol
ogou
s99
40
400
NO
DAT
A
N°
of d
onat
ion
- A
lloge
nic
1.93
80
40N
O D
ATA
N°
of d
onat
ion
- A
lloge
nic,
rel
ated
390
0N
O D
ATA
N°
of d
onat
ion
- A
lloge
nic,
unr
elat
ed1.
899
040
NO
DAT
A
BA
NK
ING
of
CO
RD
BLO
OD
N°
of u
nrel
ated
coo
rd b
lood
uni
ts c
olle
cted
1.89
50
0N
O D
ATA
N°
of u
nrel
ated
coo
rd b
lood
uni
ts d
istr
ibut
ed1
00
NO
DAT
A
N°
of u
nrel
ated
coo
rd b
lood
uni
ts a
t 31
.12
1.81
50
0N
O D
ATA
N°
of r
elat
ed c
oord
blo
od u
nits
col
lect
ed15
00
1.80
3
N°
of r
elat
ed c
oord
blo
od u
nits
dis
trib
uted
00
07
N°
of r
elat
ed c
oord
blo
od u
nits
at
31.1
214
00
011
.497
Tota
l N°
of c
oord
blo
od u
nits
col
lect
ed1.
910
00
1.80
3
Tota
l N°
of c
oord
blo
od u
nits
dis
trib
uted
10
07
Tota
l N°
of c
oord
blo
od u
nits
at
31.1
21.
955
00
11.4
97
TRA
NS
PLA
NT
N°
of t
rans
plan
ts -
A
utol
ogou
s16
00
431.
135
N°
of p
atie
nts
tran
spla
nted
-
Aut
olog
ous
132
043
0
N°
of t
rans
plan
ts -
A
lloge
nic
450
086
5
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c39
00
0
N°
of t
rans
plan
ts -
A
lloge
nic,
rel
ated
290
NO
DAT
A78
5
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c, r
elat
ed23
00
0
N°
of t
rans
plan
ts -
A
lloge
nic,
unr
elat
ed16
00
80
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c, u
nrel
ated
160
00
62
PR
ELIM
INA
RY
DAT
A O
N H
PC
CEL
LS -
YEA
R 2
011
LATI
NA
MER
ICA
N C
OU
NTR
IES
Cou
ntry
AR
GEN
TIN
AB
OLI
VIA
BR
ASI
LC
HIL
EC
OLO
MB
IAC
OST
A R
ICA
CU
BA
DO
MIN
ICA
NA
Pop
ulat
ion
(Fon
t: U
NFP
A)
40,6
10,1
196,
717
,346
,94,
711
,310
,1
CAT
EGO
RY
OF
DAT
ATY
PE
OF
DAT
AN
O D
ATA
NO
DAT
A
PO
TEN
TIA
L D
ON
ATIO
NA
ND
SEA
RC
HIN
G IN
TH
EN
ATIO
NA
L R
EGIS
TRIE
SN
° of
pot
entia
l don
ors
at 3
1.12
N°
of c
oord
blo
od u
nit
at 3
1.12
N°
of s
earc
hes
requ
este
d
N°
of u
nrel
ated
don
atio
n
DO
NAT
ION
N°
of d
onat
ion
- A
utol
ogou
s
N°
of d
onat
ion
- A
lloge
nic
N°
of d
onat
ion
- A
lloge
nic,
rel
ated
N°
of d
onat
ion
- A
lloge
nic,
unr
elat
ed
BA
NK
ING
of
CO
RD
BLO
OD
N°
of u
nrel
ated
coo
rd b
lood
uni
ts c
olle
cted
N°
of u
nrel
ated
coo
rd b
lood
uni
ts d
istr
ibut
ed
N°
of u
nrel
ated
coo
rd b
lood
uni
ts a
t 31
.12
N°
of r
elat
ed c
oord
blo
od u
nits
col
lect
ed
N°
of r
elat
ed c
oord
blo
od u
nits
dis
trib
uted
N°
of r
elat
ed c
oord
blo
od u
nits
at
31.1
2
Tota
l N°
of c
oord
blo
od u
nits
col
lect
ed
Tota
l N°
of c
oord
blo
od u
nits
dis
trib
uted
Tota
l N°
of c
oord
blo
od u
nits
at
31.1
2
TRA
NS
PLA
NT
N°
of t
rans
plan
ts -
A
utol
ogou
s0
1018
216
1521
2
N°
of p
atie
nts
tran
spla
nted
-
Aut
olog
ous
N°
of t
rans
plan
ts -
A
lloge
nic
071
410
430
40
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c
N°
of t
rans
plan
ts -
A
lloge
nic,
rel
ated
051
780
304
0
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c, r
elat
ed
N°
of t
rans
plan
ts -
A
lloge
nic,
unr
elat
ed0
197
240
NO
DAT
A0
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c, u
nrel
ated
63
PR
ELIM
INA
RY
DAT
A O
N H
PC
CEL
LS -
YEA
R 2
011
LATI
NA
MER
ICA
N C
OU
NTR
IES
Cou
ntry
ECU
AD
OR
MEX
ICO
NIC
AR
AG
UA
PAN
AM
APA
RA
GU
AYP
ERU
UR
UG
UAY
VEN
EZU
ELA
Pop
ulat
ion
(Fon
t: U
NFP
A)
14,7
114,
85,
93,
46,
629
,43,
429
,4
CAT
EGO
RY
OF
DAT
ATY
PE
OF
DAT
AN
O D
ATA
PO
TEN
TIA
L D
ON
ATIO
NA
ND
SEA
RC
HIN
G IN
TH
EN
ATIO
NA
L R
EGIS
TRIE
SN
° of
pot
entia
l don
ors
at 3
1.12
N°
of c
oord
blo
od u
nit
at 3
1.12
N°
of s
earc
hes
requ
este
d
N°
of u
nrel
ated
don
atio
n
DO
NAT
ION
N°
of d
onat
ion
- A
utol
ogou
s
N°
of d
onat
ion
- A
lloge
nic
N°
of d
onat
ion
- A
lloge
nic,
rel
ated
N°
of d
onat
ion
- A
lloge
nic,
unr
elat
ed
BA
NK
ING
of
CO
RD
BLO
OD
N°
of u
nrel
ated
coo
rd b
lood
uni
ts c
olle
cted
N°
of u
nrel
ated
coo
rd b
lood
uni
ts d
istr
ibut
ed
N°
of u
nrel
ated
coo
rd b
lood
uni
ts a
t 31
.12
N°
of r
elat
ed c
oord
blo
od u
nits
col
lect
ed
N°
of r
elat
ed c
oord
blo
od u
nits
dis
trib
uted
N°
of r
elat
ed c
oord
blo
od u
nits
at
31.1
2
Tota
l N°
of c
oord
blo
od u
nits
col
lect
ed
Tota
l N°
of c
oord
blo
od u
nits
dis
trib
uted
Tota
l N°
of c
oord
blo
od u
nits
at
31.1
2
TRA
NS
PLA
NT
N°
of t
rans
plan
ts -
A
utol
ogou
s18
174
185
077
39
N°
of p
atie
nts
tran
spla
nted
-
Aut
olog
ous
N°
of t
rans
plan
ts -
A
lloge
nic
1014
111
00
1914
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c
N°
of t
rans
plan
ts -
A
lloge
nic,
rel
ated
911
00
1914
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c, r
elat
ed
N°
of t
rans
plan
ts -
A
lloge
nic,
unr
elat
ed1
NO
DAT
A0
00
0
N°
of p
atie
nts
tran
spla
nted
-
Allo
geni
c, u
nrel
ated
64
Good Practice Guidelines in the Process of Organ Donation.
Good Practice Guidelines in the Processof Organ Donation
That “Spain is the leader in organ donations” has become a national and international slogan. It is quite clear that our system has given ampleproof of effectiveness and soundness and that our donation and transplantation activity has become a reference worldwide and is motive ofpride for our professionals and our society. Furthermore, our system is also characterized by its continuous evaluation and improvement.
Our donation and transplantation activity, although growing in absolute terms, has remained stabilized in relative terms over the last decade.A significant number of patients are faced with long periods on the waiting list and, depending on the organ, 6 to 8% of these patients on thelist die before receiving a transplant.
We are also experiencing times of fortunate epidemiological changes and changes in how society treats and confronts the end of life, changesthat give rise to doubts on the stability over time of our brain death donation potential.
It was within this context that the initiative of the present project was born: Benchmarking applied to organ donation, specifically, to braindeath donation. ‘Benchmarking’ is a modern word used to refer to a practice that is as old as the human being: innately, we establish and tryto learn from those who do it the best. The project has tried to identify those differentiating factors that justify some excellence results in thebrain death donation process by our coordination team.
These factors are summarized in the present document with the single, and we believe commendable purpose, of helping our entire coordinationnetwork to improve their results in the process. These lines serve to acknowledge that this help is supported by the fantastic work carried outby the network and its continuing enthusiasm.
Rafael MatesanzDirector National Transplant Organization
Figure 1: Structure of the donation process inbrain death donation: ICU: Intensive care unit.
1 Camp RC. Benchmarking: The search for industry best practices thatlead to superior performance. Milwukee: Quality Press, American Societyfor Quality Control; 1989.
Management of the possible
donor inside the CU
Detection of the possible donor outside the CU
Obtaining consent to organ donation
11 22 33
Detection outside CU
Detection inside CU Evaluation Brain death
diagnosisObtaining consent
Donation Process after Brain DeathDonation Process after Brain Death
Maintenance
INTRODUCTION
Within the context of the Plan Donación 40 (Donation 40Plan) propelled by the National Transplant Organization(NTO) (in Spanish, Organización Nacional de Trasplantes)to improve the organ donation and transplant activity in ourcountry, one of the strategies proposed is that of identifying,disseminating and implementing better practices applied tothe brain death donation process.
The benchmarking1 methodology has been used in order toachieve this objective. This methodology consists in defininga process and/or subprocesses, construct some indicatorsthat represent the effectiveness in their development, identify
the study units (in this case, hospitals authorized for thedonation of the deceased persons) with the best indicators(references or benchmarks) and to investigate and describethe practices that may justify these excellence results,subsequently favoring their implementation, by adaptingthem to the needs and characteristics of other centers.
In order to put this initiative into practice, a committeeformed by hospital and regional transplant coordinators andby members of the ONT was summoned. This committeedesigned the project and participated in the writing of therecommendations derived from it. The list of the BenchmarkingCommittee members is given in Annex 1.
66
For this project, the brain death donation process within thehospital setting was structured into three subprocesses (Figure 1):
1. REFERRAL OF THE POSSIBLE DONOR TOCRITICAL UNITS (CU): Detection of possible donorsoutside of the CU has not been an usual area of workin our setting, at least not in a generalized way. However,early detection and subsequent referral to the CU ofpossible donors may account for important differencesin the potential for brain death donation and therefore,in the final outcome of the process. The possible donorwas defined as a person with serious brain damageand possible evolution to brain death in a shortperiod of time. The indicator used to evaluateeffectiveness in this phase of the donation process wasthe percentage of deaths in the CU out of all the deathsin the hospital with at least one of a series of ICD-9codes among their primary or secondary diagnoses.This series of codes represents the etiology of 95% ofbrain deaths in our country.2
2. MANAGEMENT OF THE POSSIBLE DONOR INTHE CU: This is a subprocess which, in turn, includesa series of phases. Specifically, these are the detectionof the potential intra-hospital CU donor, clinicalevaluation and maintenance of a person with braindeath, as well as its diagnosis. As an indicator of theeffectiveness of this subprocess, the percentage ofappropriate donors for the extraction (pending familialconsent) was calculated out of the total number ofpersons with clinical examination consistent with braindeath within the CU. The data were obtained fromthe Quality Assurance Program in the Donation Process.3
3. OBTAINING CONSENT TO PROCEED TODONATION: Effectivity in this phase was evaluatedusing the percentage of consents to donation obtainedfrom the total number of adequate donors for theextraction, pending consent. Once again, the dataneeded for the construction of the indicator wereobtained from the Quality Assurance Program in theDonation Process.
The study setting included all those hospitals authorized fororgan donation in Spain. In order to participate in the project,the hospitals had to fulfill the requirement of havingparticipated in the Quality Assurance Program in the Donation
Process for at least 3 years out of the 5 included in the studyperiod, this including the years 2003 to and including theyear 2007. A total of 104 hospitals participated in the study,this number accounting for 68% of the hospitals authorizedfor donation in our country, although these hospitals accountedfor approximately 80% of the donors of the period studied.
After having constructed the indicators for each one of theparticipating hospitals, each one of the subprocesses andeach one of the years of study, those centers with excellenceresults in each one of the phases were identified, consideringthose determining hospital factors of the value of eachindicator (homotecia elements). Next, a questionnaire designedfor the description of their practices was sent to the intra-hospital coordination teams of these centers. Each one ofthese hospitals was visited by two members of the benchmarkingCommittee, and the corresponding questionnaire was filledout between them and the hospital coordination of the center.After, the Benchmarking committee analyzed and discussedthese questionnaires in order to extract information on thepractices that could justify these excellence results.
As a consequence of this exercise, the Committee has elaborateda series of recommendations to achieve greater effectivenessin the donation process in brain death and that are expressedin this document. A justification has been provided for eachone of the recommendations, mentioning the description ofthe findings in the hospital selected by their results, whenpertinent. It is important to stress that it was not aimed tooffer detailed step-by-step information of each one of thesubprocesses analyzed but rather of those actionsdifferentiating them from those performed in the rest ofthe hospitals, probably keys for obtaining excellent results.
The recommendations derived from this project are aimedat the entire coordination network, at the hospitaladministrations and at the heads of the hospital units, directlyor indirectly involved in the donation process.4
The purpose is to communicate these practices so that therecipients of these recommendations can evaluate the possibilityof incorporating them as far as possible and with the necessaryadaptations to their work methodology.
RECOMMENDATION ON THE COMPOSITION OFTHE HOSPITAL COORDINATION TEAM
RECOMMENDATION 1: THE NUMBER OF MEMBERSAND THE COMPOSITION OF THE COORDINATIONTEAMS SHOULD BE ADAPTED TO THECOORDINATION NEEDS OF EACH HOSPITAL
Addressed to: Hospital Administration, CU responsible persons,Hospital Transplant Coordination; Regional TransplantCoordination.
There is a variable number of members and composition ofthe coordination team in the hospitals selected based on thecoordination needs of each hospital. The number andcharacteristics of the teams have varied over time, thisresponding to the characteristics of each hospital.
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2 Cuende, N, Sánchez, J, Cañón, JF, et al. Mortalidad hospitalaria enunidades de críticos y muertes encefálicas según los códigos de laClasificaci n Internacionalla Clasificación Internacional de Enfermedades.Med Intensiva, 2004; 23(1): 1-10.
3 Programa de Garantía de Calidad en el Proceso de la Donación. Webpage of the Organización Nacional de Trasplantes. Available in: Lastaccess: November 2010.
4 Those readers of this guide who are interested in having more detailedinformation on the methodology used, on the actions performed inthe hospitals identified in this study, on the protocols or guidelines usedin them, or any additional information, please do not hesitate to consultat: [email protected]
It is very important for the regional coordinator and existingcoordination team to have in-depth knowledge about thepossibilities and needs of the center. Furthermore, a very goodrelationship needs to be established with the hospitaladministration so that it understands the importance of thedonation and transplant and therefore understands and allotsthe necessary human and material requirements to coverthese activities.
In most of the centers selected, the team is formed by medicaland nursing personnel, with a greater percentage of physiciansin the first two subprocesses (referral to CU and intra-CUmanagement). Most of the medical staff are intensivists,although it should be stressed that in the first subprocessthere are only emergency physicians, and that in the secondsubprocess there are only intensivists with somenephrologists and in the third subprocess anesthetists. Theorigin of the nursing staff is more varied, these morefrequently being from surgery in the second indicator andfrom nephrology in the third.
RECOMMENDATION 2: ALL OF THE TEAMMEMBERS SHOULD RECEIVE TRAINING INCOORDINATION AND COMMUNICATION COURSES
Addressed to: Hospital Administration, Hospital TransplantCoordination; Regional Transplant Coordination.
Almost all of the coordination team members of the centersselected have taken training courses as transplant coordinatorsand communication courses. In many cases, the team membersare even teachers of these courses.
RECOMMENDATION 3: IT IS RECOMMENDED THATTHERE SHOULD BE A STABLE COORDINATIONTEAM OVER TIME
Addressed to: Hospital Administration; Hospital TransplantCoordination; Regional Transplant Coordination
In most of the coordination teams, there is at least oneprofessional with more than 10 years of coordinationexperience, the mean years of sonority of the team beingsuperior in the third subprocess, especially in regards to thenursing staff. Therefore, the existence of certain stability inthe coordination team is important. Experience plays anessential role in all of the project phases and very especiallyin the obtaining of consent for the donation.
RECOMMENDATION 4: IT IS RECOMMENDED THATTHERE BE PERSONS WITH HIERARCHICALRESPONSIBILITY IN THE HOSPITAL IN THECOORDINATION TEAM
Addressed to: Hospital Administration, Hospital TransplantCoordination; Regional Transplant Coordination.
In several of the hospitals selected as having excellence inthe three subprocesses, section/service chiefs were includedamong the medical staff making up the transplant coordinationteam. This occurred in a lower proportion in subprocess 1,and in half of the hospitals in the subprocesses 2 and 3. Therewere also supervisors among the nursing staff, especially inphases 2 and 3 of the donation process.
The recommendation provided does not imply that havinga position of responsibility in the hospital is a requirementto opt for transplant coordination. However, based on theobservation of the centers, it is deduced that matching thecoordination of the transplant and hierarchy facilitates decisionmaking and therefore, the improvement of the effectivenessin the donation process.
RECOMMENDATION 5: IT IS RECOMMENDABLEFOR THE COORDINATORS TO HAVE PARTIALDEDICATION TO THE COORDINATION TASKS
Addressed to: Hospital Administration, Hospital TransplantCoordination; Regional Transplant Coordination.
Most of the transplant coordination staff of the centersidentified have partial dedication to the coordination tasks,all of them in the case of subprocess two. In the hospitalsthat have a person with full-time dedication, this is generallybecause of the extra workload related with thetransplantations teams. Therefore, full-time dedication ofsome of the team members is recommended in thosecenters having a large work load associated to the transplantactivity.
In every case, the part time dedication of the professionalsis combined with activities related to their professionalcategory.
RECOMMENDATION 6: DUTIES SHOULD BE BASEDON THE CONCEPT OF AVAILABILITY, ASSUMINGRESPONSIBILITY IF A DONOR APPEARS
Addressed to: Hospital Administration, Hospital TransplantCoordination; Regional Transplant Coordination.
The number of duties is generally distributed based on thenumber of team members. In general, they are based moreon the availability concept than on that of physical presence,assuming responsibility when any donor appears. On occasions,the coordination duties are shared with care work, althoughthese remain on a second plane if a possible donor appears.
In the second subprocess, the duties are always performedby at least one physician.
RECOMMENDATION 7: THE COORDINATORS MUSTHAVE FULL DECISION CAPACITY
Addressed to: Hospital Administration, Hospital TransplantCoordination; Regional Transplant Coordination.
To achieve good results in the donation process, it is essentialto have full decision capacity regarding the possible donorin all of the phases of the process. It is desirable for theCoordination Team to be able to participate in the decisionmaking when the patient is admitted to the CU and theautonomy to request the necessary tests, to negotiate theavailability of the operating room, etc.
Depending on the structure of the coordination teams, thework distribution is different. The teams made up of aphysician-nurse share the clinical and logistic work,respectively.
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RECOMMENDATION 8: IT IS ADVISABLE FOR THECOORDINATORS TO CONSIDER THAT THEY ARECORRECTLY PAID AND RECOGNIZEDPROFESSIONALLY
Addressed to: Hospital Administration, Hospital TransplantCoordination; Regional Transplant Coordination.
In practically all of the centers analyzed, the coordinationteams felt that they were somehow compensated for the largeworkload entailed by the coordination.
It is important for the administrations to recognize that thetransplant coordination work within the hospital is essential.That is why it is important to not only recognize this workeconomically but also as a merit within the professional career.
RECOMMENDATION 9: THE COORDINATION TEAMMUST BUILD AND MAINTAIN A GOODRELATIONSHIP WITH ALL THE HOSPITALPERSONNEL
Addressed to: Hospital Transplant Coordination; HospitalAdministration; Responsible for other units.
It is advisable for the coordination team to attend to all ofthe queries received from the hospital staff with a positiveattitude, helping to resolve any problem. They becomeSOLVERS AND FACILITATORS in all of the subjects relatedwith donation and transplant. The coordination team shouldbe known and be a reference for all the hospital, constitutingthe contact point for any problem or doubt related with thecoordination.
A good relationship must be maintained with the rest of thehospital and to make them aware about the donation andtransplant, facilitating the fluid course of all the process.Participation of several hospital services in the donationprocess is increasingly more frequent. It is considered to beadvisable to go towards collaboration-type models with theseunits, this favoring the sensitivity of the hospital as a whole.
Although it is considered important to act on all the hospital,some centers stress the importance of sharing their statisticswith the management and with other services, presenting themin a session, especially with those who most frequentlycollaborate with the transplant coordination (Laboratories,Pathology, Radiology, Emergency Service, Internal Medicine,Neurology, etc.).
RECOMMENDATIONS ON THE SUITABLE PROFILEOF THE HOSPITAL TRANSPLANT COORDINATION
As a common element to the three process phases in thehospitals selected, it has been seen that the coordinator formsa central axis around which all the donation process structureis constructed. Although some specific characteristics of theaspects analyzed appear in each one of the subprocesses, aseries of common traits and skills that frequently appear inthe individuals making up the coordination team of theselected hospitals are found. These are considered to beimportant in order to achieve excellent results in thecoordination tasks.
It is very difficult to speak about recommendations in thiscase, although these characteristics should be taken intoaccount when selecting a new transplant coordinator or whentraining them to improve these qualities. The fundamentalimportance of the work of the regional transplant coordinatorand the hospital administration in the selection of thehospital coordinators and their capacity to motivate themshould be stressed.
RECOMMENDATION 10: SUITABLE PROFILE OFTHE HOSPITAL TRANSPLANT COORDINATOR
Addressed to: Hospital Administration, Hospital TransplantCoordination; Regional Transplant Coordination.
MOTIVATION, DEDICATION AND WORK CAPACITY,words that are often heard when speaking about the activityof the coordinators interviewed, stand out. The enthusiasmand capacity to transmit this in order to successfully performthe work characteristic of the coordination and to achieve aGOOD RESPONSE IN THE FACE OF THE PRESSURE, sooften present in the donation process, is very positive.
Another highly valued quality is the CAPACITY FORRESPONSE. The components of the team should be personswith problem-solving capacity, this implying KNOWLEDGE,both of the hospital setting as well as the characteristics ofthe donation process, for which extensive training andpedagogic attitudes are required.
VERSATILITY is greatly related to the above, as each processis different. The search for solutions for the diversity ofsituations requires great CREATIVITY and CAPACITY FORIMPROVISATION. The coordinator should be capable ofcoping with any new situation that may arise.
It is very important for the members of the coordinationteam to have LEADERSHIP qualities, with PRESENCE ANDAVAILABILITY for the hospital staff, havingCOMMUNICATION SKILLS, GOOD CAPACITY FORRELATIONSHIPS AND EMPATHY being of great help.
RECOMMENDATIONS TO IMPROVE THEEFFECTIVENESS OF THE REFERRAL OF THEPOSSIBLE DONORS TO THE CRITICAL UNITS
RECOMMENDATION 11: THE EXISTENCE OF APROGRAM SPECIFICALLY ORIENTED TOWARDSTHE TREATMENT OF THE NEUROCRITICALPATIENT IMPROVES THE EFFECTIVENESS OF THEREFERRAL OF POSSIBLE DONORS TO THECRITICAL UNITS (CU)
Addressed to: Hospital Administration; Responsible personoutside the CU Units that attend to patients with severe braindamage; CU responsible persons, Hospital TransplantCoordination; Regional Transplant Coordination
The hospitals with the best results in this phase of the processstand out for having developed a program oriented towardsthe optimization of the treatment of the neurocriticalpatient, and not a specific program for referral to the CUof possible donors.
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In the optimization of the treatment of the neurocriticalpatient, identification of the patient with severe brain damageand its early communication to the CU for the subsequentevaluation of the case and possible admission to said unitsis contemplated as a fundamental step.
In the following, the recommendations oriented towards thedevelopment, implementation and maintenance of saidprogram are specified.
Recommendation 11.1: In the development,implementation and maintenance of said program, allof units outside the CU units attending to patients withserious brain damage must be involved.
Addressed to: Hospital Administration; Responsible personsoutside the CU Units attending to patients with serious braindamage; CU responsible persons
For a program oriented towards the optimization of thetreatment of the neurocritical patient to function adequately,it is important for ALL OF THE UNITS OUTSIDE OF THECU THAT USUALLY ATTEND TO THE PATIENT WITHSERIOUS BRAIN DAMAGE to be involved in its development,implementation and maintenance.
The unit that must be counted on fundamentally is theEMERGENCY SERVICE. However, there are other units thatcan be potentially involved in this program, depending onthe type of hospital, such as the following:
• Neurosurgery Service• Neurology Service (including the emergingStroke
Units).• Internal Medicine Service
The possibility of including other hospitals, both privateand public, in this program, for which a specific hospitalacts as reference, for the care of neurocritical patients, shouldalso be evaluated.
On the other hand, participation of the CommunityEmergency Services should be promoted.
Recommendation 11.2: In the CUs, it is essential togenerate the habit of decisions based on discussion andfor which a consensus has been reached in regards tothe action for each patient, in general, and in regards tothe neurocritical patient and possible donor, specifically.
Addressed to:Responsible persons and personnel of the CUs.
Generating the habit of making decisions after having adiscussion and reaching a consensus can be achieved byholding periodic clinical sessions that include all of the CUpersonnel. However, it is important to favor fluidcommunication within the units as well as outside of thesesessions. Doing so helps to generate common practices andattitudes, including those regarding organ donation.
Recommendation 11.3: The donation should be includedin the CU service portfolio.
Addressed to: Hospital Administration; Regional TransplantCoordination; CU responsible persons
In relationship to the organ donation, in order to favorcommon attitudes in the hospital and within the CUs, it isvery important for the institution to consider it as aCOMPREHENSIVE MEDICAL PROCESS WITHIN THEPORTFOLIO OF THE CU SERVICES.
Recommendation 11.4: It is recommendable toimplement an action protocol oriented towards theidentification of patients with serious brain damageand its early communication to the CUs.
Addressed to: Hospital Administration; Responsible personsoutside the CU Units attending patients with serious braindamage; CU responsible persons. Hospital TransplantCoordination; Regional Transplant Coordination; Care EthicsCommittee.
It is important for the hospital to have an action protocoloriented towards the identification of patients with seriousbrain damage and its immediate communication to the CUs.Such a protocol does not necessarily imply the admission ofthe patient in the CU. However, it does imply the evaluationof the case and therefore of the individual benefit of eachadmission with therapeutic objective or donation, accordingto the patient’s baseline condition and prognosis. Regardingthis action protocol:
• It should be put into practice as a CARE CONCEPT, withthe specific purpose of optimizing the management of theneurocritical patient, and in which this type of patientsare considered to be of PRIORITY.
• All of the units attending to this type of patients shouldparticipate in its elaboration. It must be a protocol that hasbeen reached by CONSENSUS.
• The CLINICAL TRIGGERS that should activate thecommunication of the existence of these patients to the CUby the units outside the CU unit must be clearly defined.Specifically, the protocol should specify what the startingpoint is on the Glasgow Scale (e.g. ≤8) to activate thiscommunication. Furthermore, this communication shouldalways occur, INDEPENDENTLY OF THE PATIENT’SAGE, ASSOCIATED COMORBIDITY AND PROGNOSIS.
• Once the clinical trigger has been specified, the protocolshould detail the action that the physician and/or nurse whoidentifies the corresponding case much carry out and specialemphasis should be placed on the NOTIFICATION SYSTEM(IMMEDIATE CALL), using the mechanism foreseen in thehospital, to the CU.
• The action protocol must also contemplate the IMMEDIATECALL TO THE TRANSPLANT COORDINATION TEAMWHEN THERE ARE POSSIBLE DONORS, if this is notautomatically represented in the previously-mentioned CU.This call can be applied to all patients with SERIOUS BRAINDAMAGE and not be exclusively limited to possible donors.The call to Transplant Coordination can be made either directlyfrom the unit outside of the CU Unit that has identified the
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case or from the CU once alerted. It is recommendable forthe Transplant Coordination to form a part of the decision-making process for the admission of possible donors in theCU, this being especially important in those cases in whichthere are doubts about the presence of absolute or relativecontraindications for the donation. In this way, the TransplantCoordinators can make an early and individualized evaluationof the cases, which facilitates the decision for the rest of theunits involved. In any case, the intervention of the TransplantCoordination must always be understood as by consensuswith all the professionals involved.
• It should be implemented INDEPENDENTLY OFWHETHER THE POSSIBLE DONOR IS either inside andoutside of the hospital (hospitalization units, emergencies,peripheral hospitals, etc.).
• It should be AVAILABLE IN WRITING.
• The protocol should include the POSSIBILITY OF ORGANDONATION as a medical reason for admission of a patientin the CU.
• The INFORMATION TO THE FAMILY on the prognosisand admission of a patient in a CU as a possible donorshould be TRUTHFUL and be provided CLEARLY,ALTHOUGH PROGRESSIVELY, AND SHOULD BEADAPTED TO THE RHYTHM OF ASSIMILATION OFTHE SITUATION. Therefore, it is recommended to makean individualized evaluation of the time and circumstancesin which this information is provided.
• The TRAINING ACTIVITY oriented at its practicalimplementation, an activity that must be aimed at unitsthat attend to patients with serious brain damage (andperipheral hospitals and community emergency services,if appropriate), should be promoted. The distribution ofTRAINING MATERIAL on this action protocol is veryadequate. Training material must include decision algorithmsthat stand out for their SIMPLICITY AND RAPIDUNDERSTANDING.
Recommendation 11.5: It is recommendable to haveprotocols on the limitation of life support treatment(LLST)
Addressed to: CU ad hoc Committee; Care Ethics Committee
These protocols must also be by CONSENSUS with all theCU staff. A MULTIDISCIPLINARY committee should beavailable for its preparation, including the nursing staff andexperts in bioethics.
The protocol should specify the importance of decisionmaking reached by consensus for the application of the LLST,in which all the personnel attending to the correspondingpatient are involved.
The existence of these protocols greatly helps the staffparticipating in the admission of possible donors in the CUin clinical decision making, systematization of the information
to be provided to the relatives of the possible donors andthe action to take if there is no evolution to brain death.
Recommendation 11.6: Performing audits outside theCU units to evaluate and monitor the effectiveness ofreferral to the CU of possible donors and identify areasof improvement is a recommendable activity
Addressed to: Hospital Administration; Responsible CU;Responsible person outside the CU units that attend to patientswith serious brain damage; Hospital Transplant Coordination;Regional Transplant Coordination
The performing of periodic audits consisting in theretrospective evaluation of clinical histories of patientsattended to outside the CU units that attend to neurocriticalpatients is a necessary task to evaluate and monitor theeffectiveness of this phase of the process and to identify areasof possible improvement. In most of the cases, said auditshould be done by consensus with the units involved andwith the sole purpose of continuing improvement.
This work can be extended to the peripheral, public andprivate hospitals (and their critical units) for which a certaincenter is of reference.
Recommendation 11.7: It is recommendable to managethe CU resources in such a way as to facilitate care tothe possible donor.
Addressed to: Responsible persons outside the CU Unitsattending to patients with serious brain damage; CU responsibleperson. Hospital Transplant coordination
BED AVAILABILITY for admission of the possible donor tothe CU is considered one of the main limitations for goodeffectiveness in this donation process phase. The generalizationof the concept of neurocritical patient (including possibledonors) as a priority patient is of special relevance. This mustbe complemented with good management of the CU beds,which is generally sufficient to solve this potential problem,including the authorization of beds belonging to the intermediateunits. In this sense, the support of the Center administrationis fundamental. Under the possibility of lack of beds in a CUand a possible donor identified outside of the unit:
• The development of the donation process outside of theCU must be facilitated with adequate cooperation betweenthe CU-unit outside of the CU-Transplant Coordination.
• When it is impossible to carrying out any of the previousmeasures, it is recommended to negotiate the transfer ofthe possible donor to a nearby hospital with immediatecapacity of admission in the CU.
RECOMMENDATION 12: THE DEVELOPMENT OFTRAINING ACTIONS, PROMOTION, AND EDUCATIONAND DONATION MATERIAL AND TRANSPLANTAIMED AT THE PROFESSIONALS OF THE CU ANDTHE UNITS OUTSIDE OF THE CU THAT ATTEND TONEUROCRITICAL PATIENTS IS RECOM MENDABLE.
Addressed to: Hospital Administration; CU responsible person;Responsible persons outside the CU Units attending to patientswith serious brain damage; Hospital Transplant Coordination
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The CONCEPT OF DONATION must be promoted as:
• A MEDICAL PROCESS THAT FORMS A PART OF THEUSUAL END-OF-LIFE CARE
• MEDICAL CAUSE OF ADMISSION IN A CU
• SHARED PROCESS, not exclusive to the TransplantCoordination.
In the following, specific recommendations are providedaimed at promoting this concept in the hospital setting,in general, and in the outside of the CU setting,specifically.
Recommendation 12.1: The development of trainingsessions oriented at the units outside of the CU thatattend to neurocritical patients on the donation processand transplant is a highly recommendable activity.
Addressed to: Responsible persons outside the CU Unitsattending to patients with serious brain damage; TransplantHospital Coordination; Hospital Administration
The performing of TRAINING SESSIONS oriented at theunits outside of CU that attend to neurocritical patients(including peripheral hospitals and community emergencyservices, if appropriate) on the donation process and transplantis a highly recommendable activity. These training sessionsmust systematically include all the staff, both medical andnonmedical, of these units.
Within the training sessions, the teaching support thatmay be provided to these units in aspects regarding THEDYING PROCESS AND ACCOMPANYING MOURNINGby The Transplant Coordination staff can be important.This is an area in which the Transplant Coordinators haveprivileged training and experience and which, at the sametime, is fundamental in the day-to-day work of theprofessionals in the units outside of the CU that attend tocritical patients.
This training effort can be complemented with the distributionof WRITTEN TRAINING MATERIAL to the units outsideof the CU on donation and transplant. In this sense, thematerial produced periodically by the hospital, regional andnational coordinations, should be proactively distributedamong the personnel of the Units outside of the CU thatattend to patients with serious brain damage.
Recommendation 12.2: The performance of periodicvisits by the Transplant Coordination to the unitsoutside of the CU that attend to patients with seriousbrain damage is fundamental.
Addressed to: Hospital Transplant Coordination
The performance of PERIODIC VISITS to the units outsideof the CU that attend to neurocritical patients by TransplantCoordination is fundamental. In this way, fluid personalrelationships are promoted and a reminder function is madeon the important role played by the personnel of these unitsin the early detection phase and that of referral of the potentialdonors to the CU.
Recommendation 12.3: Performing continuing feedbackwork to the units outside of the CU on the donationand transplant activity is important
Addressed to: Hospital Transplant Coordination; RegionalTransplant Coordination
THE PERIODIC FEEDBACK TO THE UNITS OUTSIDE OFTHE CU on the donation and transplant activity is an activityconsidered to be very important, either carried out withinthe previously-mentioned training sessions or in a moreinformal way. This feedback should consist in providinginformation on:
• The donation and results of the transplant, in general.
• The specific cases of potential donors referred to the CUin the corresponding hospital: if they become donors ornot, the reasons and the patients who have benefited fromthe donation act.
This activity is considered important in order for the personnelfrom the units outside of the CU who attend to neurocriticalpatients to feel that they are fully involved in the process andto generate a “feeling of pride” in said personnel by theiractive participation.
The ways of reinforcing this feedback activity are varied. Forexample, mention can be made of the sending of letters ina short time period by the Transplant Coordination to theunit that has participated in the detection of a potentialdonor and in its referral to the CU, informing them of theresult of the donation, when it exists.
RECOMMENDATIONS TO IMPROVE EFFECTIVENESSIN THE MANAGEMENT OF THE POSSIBLE DONORIN THE CRITICAL CARE UNITS
RECOMMENDATION 13: ALL THE MEDICALPROFESSIONALS FROM THE CRITICAL UNITS MUSTACTIVELY PARTICIPATE IN THE DETECTION OFPOSSIBLE DONORS WITHIN THE CUs
Addressed to: CU medical professionals, CU responsible persons,Hospital Transplant Coordination
In regards to the detection of potential donors, it isrecommended that all of the CU medical professionals shouldbe actively involved in the identification of patients withserious brain damage, in general, and in the identificationof potential donors, specifically. In order to facilitate thisinvolvement:
• Spreading the idea that the DONATION FORMS A PARTOF THE CU FUNCTIONS and of the END-OF-LIFE CARESis essential. To do so, it is important for the hospital torecognize that the donation forms a part of the CU serviceportfolio.
• It would also be useful to hold CLINICAL SESSIONS INTHE CU IN WHICH THE CASES ADMITTED TOHOSPITAL ARE DISCUSSED, including those with possibleevolution to brain death. In these sessions, it is importantto facilitate decision-making reached by consensus on the
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clinical approach, the possibility of donation or the needfor LLST, according to the circumstances of the case.
RECOMMENDATION 14: TO FACILITATEDETECTION OF THE POSSIBLE DONORS, IT ISRECOMMENDABLE FOR THE HOSPITALTRANSPLANT COORDINATOR PER SE TO BEINVOLVED IN THE FOLLOW-UP OF ALL THENEUROCRITICAL PATIENTS
Addressed to: CU medical professionals, CU responsible persons,Hospital Transplant Coordination
Several of the hospitals with better results in this phase ofthe process consider it to be advisable for THE TRANSPLANTCOORDINATOR (WHEN HE/SHE IS AN INTENSIVIST)TO ALSO BE ATTENTIVE TO THE FOLLOW-UP OF EVERYNEUROCRITICAL PATIENT in order to facilitate the detectionof possible donors in the CU.
RECOMMENDATION 15: IT IS ESSENTIAL THAT ALLOF THE MEDICAL PROFESSIONALS OF THE CUsTAKE RESPONSIBILITY FOR THE DIAGNOSIS OFBRAIN DEATH, THE CLINICAL EVALUATION ANDMAINTENANCE OF THE POTENTIAL DONOR, THISALWAYS BEING DONE IN COLLABORATION WITHTHE TRANSPLANT COORDINATOR
Addressed to: CU medical professionals, CU responsible persons,Hospital Transplant CoordinationIt is essential for the medicalprofessionals of the CUs to take responsibility of a potentialdonor in all of the phases of the process, counting on, ofcourse, adequate nursing staff at all times and on the TransplantCoordinator.
The decision to rule out a donor should always be reachedby consensus with the Transplant Coordinator. Although itis important for all the medical professionals of the CUs toparticipate in the evaluation of the potential donors and tobe familiarized with absolute contraindications regardingorgan donation, said evaluation should always be performedin close collaboration with the Transplant Coordinator. Inthis way, losses in the process due to inadequate medicalcontraindications are avoided or minimized.
RECOMMENDATION 16: IT IS IMPORTANT TODEFINE THE PERMANENT AVAILABILITY OFMEDICAL SPECIALISTS IN NEUROLOGY,NEUROSURGERY AND/OR NEUROPHYSIOLOGYFOR THE DIAGNOSIS OF BRAIN DEATH
Addressed to: Hospital Administration; Hospital TransplantCoordination; Regional Transplant Coordination
If this center cannot count on the permanent presence ofthese professionals (24h/365d), specifying the shift of thespecialist available as well as the way to contact them inorder to be able to request their collaboration, if necessary,is recommended. This information should be easily assessablefor all of the CU staff.
RECOMMENDATION 17: IT IS RECOMMENDEDTHAT THE HEALTH CARE CENTER HAVE ATRANSCRANIAL DOPPLER
Addressed to: Hospital Administration; CU responsible person
When providing the diagnosis of brain death, it is essentialto be able to count on the possibility of a flow test. In thissense, it is recommended that the centers authorized for thedonation process should have a transcranial Doppler as wellas professionals trained in the management and interpretationof this diagnostic technique.
RECOMMENDATION 18: IT IS ESSENTIAL TOPERMANENTLY HAVE AVAILABLE AMICROBIOLOGY LABORATORY AND A PATHOLOGYLABORATORY
Addressed to: Hospital Administration; Regional TransplantCoordination; Hospital Transplant Coordination
If the center does not have a permanent microbiologylaboratory or a pathology laboratory (24h/365d), then it isrecommended that this center should have a plan establishedfor the sending of samples to a reference laboratory. In thisway, the need to improvise when faced with complicated orspecial situations when making an adequate clinical evaluationof a possible donor is avoided. This information should beeasily assessable to all of the CU personnel.
RECOMMENDATION 19: IT IS IMPORTANT TO HAVEWRITTEN PROTOCOLS REGARDING THEDETECTION, EVALUATION AND MAINTENANCEOF POSSIBLE DONOR AND THE DIAGNOSIS OFBRAIN DEATH
Addressed to: CU responsible persons; CU Medical Professionals,Hospital Transplant Coordination
Those hospital standing out for their effectiveness in theintra-CU management of possible donors have writtenprotocols regarding the different phases of the donationprocess that take place within the CUs.
It is not only recommendable to have these protocols butalso for the medical personnel or nonmedical personnel ofthe CUs to be familiarized with them, for the protocols tobe easily accessible to all of the professionals involved andthat these protocols be periodically updated.
Training should be carried out for all of the CU personnelthat would make it possible to put these protocols intopractice.
RECOMMENDATION 20: IT IS IMPORTANT TO HAVEA GOOD WORK ENVIRONMENT AND FLUIDCOMMUNICATION WITHIN THE CUs
Addressed to: CU responsible persons; CU Medical Professionals,Hospital Transplant Coordination
It has been seen that the best results are registered in unitswith a good work ambient between all of the professionalsinvolved. This facilitates the active involvement of all theprofessionals in the donation process.
Several aspects have been identified as having been identifiedby the professionals of the center selected as key points:
• Good work environment between the medical professio -nals.
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• Good medical-nurse communication/relationship.• Team work.
RECOMMENDATION 21: CONTINUING EDUCATIONOF ALL THE PERSONNEL IN THE CRITICAL UNITSIN THE ORGAN DONATION PROCESS IS ANESSENTIAL ELEMENT
Addressed to: CU responsible persons; CU Medical Professionals,Regional Transplant Coordination; Hospital TransplantCoordination
It is recommended that specific and continuing educationin donation and transplant of all the health care professionalsworking in the CU be promoted.
The training of the resident physicians in the setting shouldbe encouraged.
It is recommended that the origin of this training effortshould begin on all the levels of health care administration:that is, national, regional and hospital.
RECOMMENDATIONS TO IMPROVE EFFECTIVENESSIN OBTAINING CONSENT FOR DONATION
RECOMMENDATION 22: THE INTERVIEW WITHTHE FAMILY MEMBERS OF THE POSSIBLE DONORSHOULD FOLLOW A SPECIFIC METHODOLOGYAND SHOULD BE PLANNED AS MUCH AS POSSIBLE
Addressed to: CU Responsible persons; CU Medical Professionals,Hospital Transplant Coordination
Although each interview is different, a methodology withsequential, clearly defined phases that should not be mixedshould be used.
Recommendation 22.1: The interview should always beprepared. It is important to obtain information on thefamily, plan the site where the interview will be conductedand how the death will be communicated, advise thefamily in good time and organize the necessary humanand material resources.
Addressed to: CU Personnel; Hospital Transplant Coordination
The centers consulted recommend preparing any aspectrelated with the interview that may influence its result,reducing the need to improvise as much as possible.
Those elements that these centers recommend to prepare aheadof time are mentioned in the following:
• It is important to speak with the professionals who haveattended to the possible donor to gather information onthe family (without interpreting or prejudging the result).It is possible to know in advance if it will be necessary tocount on cultural cooperators and/or translators, or whoare the persons who are necessary for the decision ondonation.
• It is recommended to communicate in good time to all ofthe direct family members regarding the importance of
their coming to the center to receive information regardingthe situation and prognosis of the patient. This request toappear makes it possible for all of those who should beincluded in the decision to come. If necessary, it should bestress that it is important that all of the family memberscome with sentences such as “It would be best if they come,”“it is better that I explain it to them.”
• When there are social, cultural or idiomatic type barriersor difficulties, the support of a cooperating person, translatorand friends of the possible donor with a greater level ofintegration or of religious references whose cooperationmay be beneficial for the family can be foreseen. Thesepersons should be previously informed about the donationso that they can support the family and maintain a favorableattitude and not be limited to making a simple translation.
• It is important that the family be gathered together in arelaxed atmosphere, where they can speak in privacy, andnot far from the donor, since they frequently may want tosee him/her.
• The interview should be prepared with the professionalwho is going to communicate the death. This is usuallythe medical professional who has been responsible for thepatient. However, if this is not possible, a medical professionalfrom the same service should be sought, ideally someonetrained in communication techniques. The informationthat will be given to the family and how to communicateit, including the communication of the death, should beprepared.
• If the condition of the donor or the situation of thefamily allows for it, it is preferable to avoid conductingthe interview at night. They are generally more restedand more receptive during daylight. (See recommendation24.2).
Recommendation 22.2: It is considered appropriate tonot limit the number of persons who participate inthe interview. All those persons who are important forthe decision should be present and contact should bemaintained with them.
Addressed to: CU personnel; Transplant Hospital Coordination
All those persons who are important when making thedecision should be present. The exclusion of anyone couldentail the risk of excluding those who are relevant.
It is recommendable to identify all those who, due to theirclose relationship to the donor or their leadership positionor capacity, may have greater influence in the decision ofthe group.
The coordinators should not lose contact with anyone inthe group. During the interview, the group should not beallowed to disintegrate. Therefore, if anyone wants to leavefor a short time, they should not be prevented from doingso (one of the coordinators can accompany this person), butthey should return, since a unanimous decision is desirable,without discrepancies within the group.
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Recommendation 22.3: It is recommended thatprejudging the result of the interview should be avoidedand an attempt should always be made (except in thosecases in which it is known with certainty that thetransplant cannot be performed). Furthermore, nomaximum time for the interview should be pre-established.
Addressed to: CU Personnel; Hospital Transplant Coordination
The hospitals consulted answered unanimously that the interviewshould always be conducted, except when it is known thatthe transplant cannot be done, for example, when there areno appropriate recipients in the case of an infant donor.
The variability in the interview duration is considered to beenormous. Limits regarding the duration of the interviewshould not be established beforehand.
Recommendation 22.4: It is very important to establisha professional relationship of help that facilitates thenecessary trust so that the relatives accept the optionfor donation. To do so, it is essential to know and touse the communication tools
Addressed to: CU Personnel ; Hospital Transplant Coordination
Establishing a good relationship with the family based ontransparency, empathy, emotional support and therelationship of professional help is considered to be veryimportant. The relationship of help should be created withthe relatives from the beginning and maintained duringthe entire interview. It is also recommendable to usecommunication elements, such as open questions, reflectionof emotions, active listening or paraphrasis.
During the interview, it is advisable to allow them to speakwithout interfering while they are speaking and to respecttheir silences. Physical contact is important if the familyshows that they require it.
At the end of the interview, it is important to continuemaintaining the relationship of help to the relatives until theend. This should end with signs of condolence and affect,independently of its outcome.
Recommendation 22.5: The interview is structured intoa series of successive and independent sentences:initiation, communication of death, request for consentto donation, and completion. Different phases of theinterview should not be mixed and it is important tomake sure that the family has understood the fact ofdeath before requesting the consent.
Addressed to: CU Personnel ; Hospital Transplant Coordination
Several teams consulted recommend that the team thatintervenes in the interview should be made up of the medicalprofessional who has been responsible for the patient (oranother from the same service, if this is not possible) whowill be in charge of communicating the death and by twopersons from the transplant coordination team, usually onephysician and one nurse, with training in communication
techniques. Alternatively, if there are only two persons, onewill communicate the death and the other will request theconsent for donation.
It is considered to be very important to establish therelationship of help with the family from the beginning andto maintain it to the end, since according to the experienceof the centers interviewed, in addition to the support thatthis relationship supposes for the family in very difficultmoments, it increases the likelihood that the family willaccept the donation.
The medical professional who is responsible for the patientshould be the one who begins the interview and presentsthe coordinator team by their first and last names. However,that fact that they are transplant coordinators should notbe revealed, except under exceptional situations (for example,the previous request for donation by the family).
Once the interview has been initiated, the communicationof death can be made by the intensivist with the supportof the coordinators (See Recommendation 22.6.)
Once the death has been communicated, the responsibilityof directing the interview should undergo a change, so thatthe coordinators can assume a more important role in thecommunication with the family. The person who hascommunicated the death can leave the room and attend toother work, explaining it to the family.
Before going on to the request for donation, it is veryimportant for the coordinators to assure that the family hasunderstood the fact of the death. If this is not so, they shouldcontinue to give the necessary explanations that will helpthem to accept the situation, maintaining the relationshipof help. The family should set the rhythm. Only after thefamily expresses, through their manifestations of recoveryof emotional control and approach to action, that it hasunderstood and assumed the death of their relative, canthe coordinator continue with the next phase.
Recommendation 22.6: The communication of deathshould be made by the patient’s physician, who willanswer any questions the family may have. There is noclear recommendation on the communication of death,simply, or brain death.
Addressed to: CU Personnel ; Hospital Transplant Coordination
Once the presentations have been made, the communicationof the death should be made by the intensivist with thesupport of the coordinators who, apart from exceptions, willnot identify themselves as such at the beginning of thepresentations (See Recommendation 22.5)
It is recommended that the communication of death beginswith established communication formulae similar to “asyou already know, the situation of your relative was veryserious,” “unfortunately we have bad news,” or “the situation,unfortunately, has worsened,” that give rise to thecommunication and explanation of the death, answeringall of the questions asked by the relatives and encouraging,with open questions, the relatives to clarify their doubts.
There is no clear recommendation on the communicationof death, simply, or brain death.
Once the death has been communicated, it is recommendedthat the coordinators take charge of the interview, assuminga greater role in the communication with the family, askingabout any problems and needs they have and offering thenecessary help. As previously mentioned, the person whohas communicated the death can leave the room and attendto other tasks, explaining this to the family.
Recommendation 22.7: The request for consent fordonation should be made clearly, directly and plainlyby the coordinator, as an option, a right, a privilege,or way of helping others. This should always occurafter verifying that the family has understood the factof death.
Addressed to: Hospital Transplant Coordination
Before requesting the donation, it is very important for thecoordinators to ensure that the family has understood thefact of death and that they have no other problem or concernthat may be interfering with it. On the contrary, the problemsshould be discovered through open questions and support,explanations or different ways of approaching the problems(relationship of help) should be offered. As has already beenmentioned, the family should set the rhythm, and only whenthey have expressed, through their manifestations of recoveryof emotional control and action approach, that they haveunderstood and assumed the death of their relative, can thecoordinator continue on to the next phase.
The request for donation should be stated clearly, directlyand in plain language. Exaltation of values is important: itis recommended that an option, right, privilege, or apossibility of helping others be offered. It is very importantto ask what opinion the deceased had (or could have)regarding donation.
Recommendation 22.8: In the case of a negative response,rejection reversal techniques are recommended. Thefamily will establish when the interview ends.
Addressed to: Hospital Transplant Coordination
In the case of a negative response, the centers consulted useddifferent techniques:
• Asking the family to express the reasons for the rejection.Once they are expressed, they can be analyzed andappropriately refuted. Solidarity reasons can be used.
• If lack of empathy is detected, it is advisable to make a changein the person steering the interview and for that person toact in the background.
• Give them time, approaching arguments that seem importantfor the family and maintaining contact, leaving aside thedonation, without insisting on it, for some time.
• Identify the persons involved in the rejection and their rolewithin the family, attempting to communicate separatelywith the negative member, so that this member does nothide and reaffirm in the group and so that the discrepancycan be reduced, everyone assuming the final decision.
The family should set the limit of the interview. The centersconsulted state that they stop trying it when the family showsigns that there is no progression, empathy is lost, and orif it is not providing any benefit to them.
Recommendation 22.9: Regardless of the outcome ofthe interview, it should end with signs of condolencesand affect, maintaining the relationship of help untilthe final moment
Addressed to: CU Personnel ; Hospital Transplant Coordination
The relationship of help is a benefit for the family that shouldbe maintained until the end.
Recommendation 22.10: It is recommended that somedays later the family should be thanked for the donationthrough a letter or telephone call
Addressed to: Hospital Transplant Coordination
This makes it possible to formally close the relationshipestablished with the family and generate a positive opinionon the donation.
Recommendation 22.11: The interviews should bedocumented and then analyzed, especially the rejections
Addressed to: Hospital Transplant Coordination
Recording the activity performed makes it possible to evaluatethe opportunities to improve, since it facilitates the analysisa posteriori of the case and of the possible alternatives to theapproach taken. Furthermore, it makes it possible to provokean educational discussion in the team on ways to respondto the rejection presented.
RECOMMENDATION 23: IT IS IMPORTANT FORTHE TEAM INTERVENING IN THE INTERVIEW TOHAVE SPECIFIC TRAINING
Addressed to: Hospital Administration; CU responsible person;CU Medical Professional; CU Personnel ; Hospital TransplantCoordination; Regional Transplant Coordination
It is very important for the persons who participate in theinterview to have specific training for the roles they assume.These involve elevated difficulty and require specific attitudes.
Recommendation 23.1: It is advisable for the medicalprofessional who communicates the death to havetraining in the techniques of communicating bad news
Addressed to: Hospital Administration; CU responsible person;CU Medical Professional; Hospital Transplant Coordination
The teams interviewed consider that training in communicationof bad news is essential. If, due to exceptional circumstances,the medical professional selected does not have this training,the coordination team should carefully prepare the approachto the family, the information that must be given and onhow to communicate it (See recommendation 22.1.)
It is important for the co-coordinators to promote specifictraining of the professionals in the critical units in thesesubject matters through courses and seminars held withinthe hospital.
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Recommendation 23.2: The transplant coordinationteam should have experience and receive continuingeducation in all of the aspects related with the interview
Addressed to: Hospital Administration; CU responsible person;CU Medical Professional; Hospital Transplant Coordination;Regional Transplant Coordination
The persons who request the consent for donation shouldbe transplant coordinators with specific training in donationand transplant, relationship of help and techniques ofcommunicating bad news. In order to renew and updateconcepts, the personnel of the centers consulted periodicallyreceive training, even if they have previously received thistraining.
At least one of the coordinators should have experience,which is highly considered by the centers.
Equally, in the centers consulted, the active participation ofthe nursing service belonging to the coordination teams inthe request is stated. Their skill to develop complicity andto establish relationship of help in some very difficult momentsis recognized.
It is important for the professionals involved to receive specifictraining in order to avoid the emotional overload that thistype of work may give rise to.
Recommendation 23.3: There is no clearrecommendation on the profile of the cooperatorpersonnel
Addressed to: Hospital Administration; CU responsible person;Hospital Transplant Coordination; Regional TransplantCoordination
Except for one of the hospitals with excellence results in theconsent obtaining phase for the donation, the centers do nothave their own cooperator personnel. The ideal situationwould be for the translator who generally cooperates withthe coordinators to receive specific training in donation andtransplant and in the relationship of help, and not be onlylimited to translating.
RECOMMENDATION 24: IT IS IMPORTANT TO HAVERESOURCES FOR CARRY OUT THE INTERVIEW
Addressed to: Hospital Administration; Responsible personoutside the CU units; Hospital Transplant Coordination
Recommendation 24.1: It is recommended to alwaysmake the interview in a separate place, with privacyand resources that cover the minimum needs
Addressed to: Hospital Administration; CU responsible person;Responsible person outside the CU units; Hospital TransplantCoordination
It is important to have privacy to allow the family to expresstheir emotions and freely communicate among themselvesand with the interviewers.
It is advisable to have resources that cover the minimum needs(telephone, handkerchiefs, water, some food, etc.)
Some centers consider it important to have several rooms
that make it possible to change sites if the coordinator
considers it to be necessary. For such effect, they distinguish
between the room for information to the family and the
mourning room.
It is recommended to conduct the interview in a place where
the family is not far from the donor. They may frequently
request to see the donor.
Recommendation 24.2: It is advised to conduct theinterview in the morning, with daylight
Addressed to: CU Medical Professionals; Hospital Transplant
Coordination
At this time of the day, they are generally more rested and
more receptive. However, it is not uncommon for reasons
to exist, such as emotional condition of the family, distance,
availability of flights, etc., that make it impossible to do so
in the morning. In these cases, the situation of the family
and the relationship of help established with them comes
first and the interviews should be made when necessary.
Recommendation 10:Recommendation 24.3: If thereare incentives for the family, it is recommended to notuse them as an argument to obtain donation or reversea rejection
Addressed to: Hospital Transplant Coordination
The centers consulted that may have incentives for the family,
such as transfer of the cadaver or coverage of some of the
funeral costs, do not use this argument to obtain consent.
This possibility should be commented, when it can be applied,
after having obtained consent for donation.
RECOMMENDATION 25: OTHERRECOMMENDATIONS OR SUGGESTIONS
Recommendation 25.1: It would be desirable to havecounseling available on material of interviews, religion,language, etc.
Addressed to: Hospital Transplant Coordination; Regional
Transplant Coordination; National Transplant Organization
Without detriment to the training received in the capacity
to improvise, the centers consulted consider that it would
be convenient to have specific counseling when there are
cultural, linguistic difficulties or others.
Recommendation 25.2: The relationship of help is a greatbenefit for the family. It should not only be applied todonation.
Some centers consider that the outcome of the relationship
of help is positive, and recommend that using it should not
be limited only to those cases in which the possibility of
donation.
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ANNEX 1: BENCHMARKING COMMITTEE MEMBERS
Arráez Jarque, Vicente Hospital General Universitario de Elche
Bouzas Caamaño, Encarnación Coordinación Autonómica de Galicia (Regional Coordination of Galicia)
Castro de la Nuez, Pablo Coordinación Autonómica de Andalucía (Regional Coordination of Andalusia)
Coll Torres, Elisabeth Organización Nacional de Trasplantes (National Transplant Organization)
de la Concepción Ibáñez, Manuel Coordinación Autonómica de la Comunidad Valenciana (Regional Coordination ofthe Valencian Community)
de la Rosa Rodríguez, Gloria Organización Nacional de Trasplantes (National Transplant Organization)
Domínguez-Gil González, Beatriz Organización Nacional de Trasplantes (National Transplant Organization)
Elorrieta Goitia, Pilar Hospital de Cruces
Fernández García, Antón Hospital Universitario La Coruña
Fernández Renedo, Carlos Coordinación Autonómica de Castilla y León (Regional Coordination of Castilla y Leon)
Galán Torres, Juan Hospital Universitario La Fe
Getino Melián, María Adela Hospital Nuestra Señora de la Candelaria
Gómez Marinero, Purificación Hospital General de Alicante
Marazuela Bermejo, Rosario Organización Nacional de Trasplantes (National Transplant Organization)
Martín Delagebasala, Carmen Organización Nacional de Trasplantes (National Transplant Organization)
Martín Jiménez, Silvia Organización Nacional de Trasplantes (National Transplant Organization)
Martínez Soba, Fernando Coordinación Autonómica de La Rioja (Regional Coordination of La Rioja)
Masnou Burallo, Núria Hospital de Vall d’Hebrón
Rodríguez Hernández, Aurelio Coordinación Autonómica de Canarias
Salamero Baró, Pedro Hospital de Vall d´Hebrón
Sánchez Ibáñez, Jacinto Coordinación Autonómica de Galicia (Regional Coordination of Galicia)
Serna Martínez, Emilio Organización Nacional de Trasplantes
(National Transplant Organization) Special thanks is given to Adela Moñino Martínez, a psychologist from the DiputaciónProvincial (Regional Council) of Alicante, for her contribution to the design and writing of the questionnaire for the study onthe effectiveness in obtaining the consent to donation and the contents of the recommendations in the mentioned subprocess.
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Co-operation between countries of the Black SeaArea (BSA Project): Development of the activities
related to donation and transplantation
Co-operation between countries of the Black Sea Area(BSA Project): Development of the activities related to
donation and transplantation
PROJECT BACKGROUND
The Council of Europe, based in Strasbourg (France), is aninter-governmental organisation that covers, by virtue of its47 member states, the entire European continent. Foundedin 1949, the Council of Europe promotes human rights,democracy and the rule of law. The work of the Council ofEurope in the area of organ transplantation started in the1980s. In particular, blood transfusion and organtransplantation activities are managed from the EuropeanDirectorate for the Quality of Medicines & HealthCare(EDQM), a Directorate of the Council of Europe. The EDQMis a leading organisation that protects public health bysupporting the development, implementation and applicationof quality standards for medicines and healthcare.
The European Committee on Organ Transplantation (CD-P-TO) is the steering committee in charge of organtransplantation activities at the EDQM. It actively promotesthe non-commercialisation of organ donation, the fightagainst organ trafficking and the development of ethical,quality and safety standards in the field of organ, tissue andcell transplantation. Its activities include the collection ofinternational data and monitoring of practices in Europe,the transfer of knowledge and expertise between organisationsand experts through training and networking and theelaboration of reports, surveys and recommendations.
The development of organ transplantation activities in thecountries of the Black Sea Area (BSA) date back from thelate 1970s but, from the early 1990s, they began to declineand, in some countries, even ceased. Therefore, it has becomeextremely crucial to identify and share experience with themfrom countries with well-developed and establishedtransplantation programmes and from other local initiatives,which could provide models for the implementation of safedonation and transplantation programmes in the BSAcountries, according to their developmental and culturalbackgrounds.
In this context, in 2011, the Council of Europe launched athree-year collaborative project that aims to battle organshortages and to improve access to transplant health servicesin the Council of Europe BSA member states (Armenia,Azerbaijan, Bulgaria, Georgia, Moldova, Romania, RussianFederation, Turkey and Ukraine) through the developmentof safe and ethical donation and transplantation programmes.Efforts are mainly being directed towards the developmentof effective legislative frameworks and the establishment ofnational transplant authorities and national transplantprogrammes and infrastructures. Specialists in the field oftransplantation from countries with established transplant
systems, such as France, Italy, Czech Republic, Portugal andSpain, are participating and supporting experts from theBSA countries. The intention is to create a permanent networkof national experts that will allow the participating countriesto co-ordinate their efforts and pool resources.
PROJECT STRUCTURE AND ACTION PLAN
The BSA Project has been organised into several WorkPackages that focus on different aspects of the various donationand transplantation processes, which are based on the levelof development of the already existing transplantation activitiesin each BSA member state.
WP1: Project Management
The Council of Europe is in charge of the overall managementof the project. A Steering Committee, consisting of expertsfrom national transplant authorities and organisations fromcountries with well-developed transplant programs, has beenconstituted to guide and ensure the successful developmentof the project.
WP2: Development and implementation of an effectivelegislative and financial framework
Participating member states: Armenia, Azerbaijan andGeorgia. Work package leaders: Agence de la Biomédecine(France) and Czech Transplantations Co-ordinating Centre(Czech Republic).
This Work Package focuses on the development andimplementation of effective legislative and financial frameworksfor transplantation activities. The countries participating inthis Work Package have legislation on organ transplantation,but no established national transplant organisations. Thereis some existing organ transplantation activity from livingdonations, but no deceased donation programmes. This WorkPackage focusses on the assessment of existing transplantlegislation, the financial provisions in each country relativeto health programmes and transplantation activities, theinstitutional and structural obstacles for the development oftransplantation and the political will to develop suchprogrammes.
Between December 2011 and March 2012, information aboutthe countries was collected using a number of questionnairesand subsequently analysed. On April 2012, a delegation ofexperts visited the three countries to complete data collection.Based on the country reports elaborated, a number ofindividual recommendations were produced for each country.These recommendations will be submitted to the threecountries and discussed further.
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WP3: Establishment of National Transplant Authorities
Participating member states: Bulgaria, Moldova and Ukraine.Work package leaders: Centro Nazionale Trapianti (Italy)and the Autoridade para os Serviços de Sangue e daTransplantaçao (Portugal).
This Work Package focuses on the establishment of NationalTransplant Authorities. The countries participating in thisWork Package have already established National TransplantOrganisations and, some of them, minimal deceased donationactivity. This Work Package focuses on the evaluation ofthese existing organisational systems and their functionalityin order to identify areas for intervention and improvement.
Between December 2011 and March 2012, information aboutthe countries was collected using a number of questionnairesand subsequently analysed. The planned site visits will beessential to complete the country evaluations and for theelaboration of individual recommendations and nationalaction plans.
WP4: Clinical Practices
Participating member states: Romania, Russian Federationand Turkey. Work package leaders: DTI Foundation andOrganización Nacional de Trasplantes (Spain).
This Work Package focuses on analysis of the clinical practicesfor the donation-transplantation process inside hospitals.The countries participating in this Work Package haveestablished National Transplant Organisations and have fullyfunctional living and deceased donation programmes.
Between December 2011 and January 2012, informationabout the countries was collected using a number ofquestionnaires and analysed. A delegation of experts visitedTurkey in March 2012 to assess existing clinical practices andto speak to representatives from the Ministry of Health. Sitevisits to Romania and Russian Federation will be scheduledshortly and will allow completion of the country evaluations.Individual recommendations and national action plans willbe elaborated thereafter.
NEXT ACTIONS
Two courses of action will be established for each of theparticipating countries:
• Governmental level -> working with the governmentsand Ministries of Health to engage political involvementthrough site visits and direct meetings.
• Technical level -> working directly with the nationaltechnical experts at a practical level. Specific tasks and goalswill be defined for each country and appropriate trainingwill be provided to accomplish them. There will be continuousfollow-up of progress and the results will be evaluated afterthe first year.
CONTACT
Marta López Fraga PhD, Scientific Officer, EDQM, Councilof Europe: [email protected]
Tel. +33 (0)3 90 21 45 30; Fax +33 (0)3 88 41 27 71
Web Pages: http://www.edqm.eu http://www.coe.int
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Transplantation of Non-Nationals andNon-Residents in the Countries of the Council of
Europe: Results of a Survey Conducted in theContext of the Initiatives of the European
Committee on Organ Transplantation (CD-P-TO)
84
This study on transplantation for non-nationals/non-residentsin the member states of the Council of Europe commencedin 2008 as an initiative of the European Committee (PartialAgreement) on Organ Transplantation (CD-P-TO) of theCouncil of Europe and was co-ordinated by the ItalianNational Transplant Centre (CNT).
The CNT circulated a questionnaire to the health authoritiesof the 35 member states of the Council of Europe, to membersof the CD-P-TO and to two trans-national transplantorganisations.
The main objective of the survey was to investigate various
aspects related to transplantation in non-nationals/non-
residents, especially with regard to access to waiting lists,
transplantation (including from living donors), allocation and
health and social assistance provided to non-nationals/non-
resident patients.
Twenty-nine of the 37 agencies contacted returned the
questionnaire (Table 1) and the results of the survey are
presented in this report.
Transplantation of Non-Nationals and Non-Residentsin the Countries of the Council of Europe: Results of aSurvey Conducted in the Context of the Initiatives ofthe European Committee on Organ Transplantation
(CD-P-TO)Carella C, Cozzi E, Di Ciaccio P, Nanni Costa A.
Italian National Transplant Centre (CNT), Rome, Italy
Austria Medical University Wien
Belgium Ministère de Santé Publique
Bulgaria Executive Agency of Transplantation
Cyprus Paraskevaidion surgical and transplant center of Cyprus
Czech Republic National Transplantations Coordinating Center
Denmark Rigshospitalet
Estonia Tartu University Hospital
Eurotransplant
Finland Division of Transplantation, Helsinki University
France Agence de la Biomédecine
Georgia Georgian Association of Transplantologists
Germany Deutsche Stiftung Organtransplantation
Greece Hellenic Transplant Organization
Hungary Department Of Transplantation and Surgery, Semmelweis University
Iceland Ministry of Health
Ireland Department of Public Health
Italy Italian National Transplant Centre
Luxembourg Luxembourg Transplant
Moldova Republican Clinical Hospital
Netherlands National Board of Health and Welfare
Norway Oslo University Hospital
Poland Poltransplant
Portugal Autoridade Dos Serviços De Sangue E Transplantação
Romania National Transplant Agency
Slovenia Institute for Transplantation of Organs and Tissues of the Republic of Slovenia
Spain Organización Nacional de Trasplantes
Sweden National Board of Health and Welfare
Switzerland Swisstransplant
United Kingdom National Health Service
Table 1. List of countries/authorities participating in the survey.
Countries withrestrictinglaws/regulations
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Definitions:
For the purpose of this survey, the status of non-residentsand non-nationals was defined according to the currentdefinitions in the Italian legislation and these definitionswere made available to the participating countries when thequestionnaire was distributed.
In particular, residency is defined as the act of establishingor maintaining a residence in a given place, regardless ofnationality and race. Residency can be either legal (throughnationality, permanent or temporary residency card or asylumseeker or refugee status) or illegal. In case of legal residency,citizens are obliged to be registered by national authoritiesand pay insurance or social security fees, health care coverageand/or taxes, depending on the national laws. A resident caneither be a national or an alien with legal temporary orpermanent residency status. In the case of asylum seekersand refugees, the resident status is automatically granted.
Non-residents are individuals who are not residing whereofficial duties require them to reside. A non-resident couldbe a national citizen living abroad or an alien withouttemporary or permanent residency status. Tourists and peopleresiding illegally in a country are considered non-residents.
ACCESS TO WAITING LISTS AND TOTRANSPLANTATION
With regard to access to waiting lists and to transplantation,all but seven of the national health authorities that returnedthe questionnaire declared that there was a restrictinglaw/regulation in force in the country regarding non-resident/non-national individuals (Table 2).
Different restricting criteria, however, are used in the 21remaining countries and, in some cases, more than one setof restricting criteria are applied (Table 3). In 77.3% of thecountries answering the questionnaire, residency is used as arestricting criterion, and in 3 countries, nationality or citizenshipis an additional restricting element. Fifty per cent of respondentshad other restricting criteria, including having health insurancecoverage or coverage by a social security system or privatefunding. Evidence of financial coverage (health insurance,social security system or private funding) was the uniquerestricting element in just one country. Finally, the presenceof a bilateral health co-operation agreement was reported asan additional restricting criterion by 22.7% of respondents.It is noteworthy that none of the countries replying to thesurvey reported patients’ ethnic origin as a restricting criterion.
The national parliament was reported as the institutionissuing the regulations in place for non-resident/non-nationalindividuals in 61.5% of countries whilst, in 23% of countries,a specific ministry was the primary promoter of the legalframework through decrees, guidelines, by-laws or otherinstruments. In the remaining countries, a central role for aNational Organ Transplant/Procurement Organisation or arole for regional/administrative/local authorities was reported.
The regulations in place are legally-binding in 86.9% of thosecountries that responded, of which 90% have a mechanismto ensure compliance.
Interestingly, the countries within Eurotransplant (ET) areexpected to adhere to the “5% non-resident rule”, whichrequires that the number of non-resident listings per centrefor liver, heart and lung transplantation should not exceed5% per year of the total number of patients transplantedwith an organ from a deceased donor in the previous calendaryear. All transplantations from deceased donors are used forthe determination of compliance with the “5% non-residentrule”, with the exception of:
Paediatric patients who are successfully transplanted with aleft lateral liver split, in the event that the (extended) rightlobe of the same donor organ is also transplanted;
Patients from a non-ET twinned country or centre who arelisted on the waiting list or the ET twinning centre, in caseof an approved twinning agreement.
Non-compliance with the “5% non-resident rule” iscommunicated by ET to the centre concerned and to the Boardof ET on a regular basis (at least annually). The “5% non-
Countries without arestrictinglaws/regulations
Table 2. Countries with or without a restricting law/regulation in forcefor transplantation of non-resident/non-national patients.
Table 3. Restricting criteria that impact on access to transplantationwaiting lists for non-resident/non-national patients.
Austria Cyprus
Belgium Estonia
Bulgaria Georgia
Czech Republic Ireland
Denmark Moldova
Finland Portugal
France Romania
Germany
Greece
Hungary
Iceland
Italy
Luxembourg
Netherlands
Norway
Poland
Slovenia
Spain
Sweden
Switzerland
United Kingdom
Residency 77.3%Nationality 14%Ethnic origin NoneHealth insurance, socialsecurity system or privatefunding 50%
Bilateral health agreement 22.7%
PERCENTAGERESTRICTINGCRITERION
86
resident rule” does not apply to kidney and pancreas recipients,on the understanding that these patients are not allowed tobe registered on the ET waiting list.
In the ET countries (where the “5% non-resident rule” isapplied), and in Cyprus and Romania due to the absence ofa regulatory framework or specific restrictions, virtually anyperson (including non-nationals and non-residents) in thecountry can have access to transplantation.
The existence of special provisions at a national or local levelfor asylum seekers, refugees and non-residents in a countryfor humanitarian reasons were reported in 58.3% of therespondents.
In order to fully comprehend the situation in terms of accessto the deceased waiting list in the various Council of Europemember states according to citizenship and residency status,the questionnaire included specific questions, summarisedin Figure 1.
ALLOCATION
In 91.6% of cases, non-nationals and non-residents are notdisadvantaged compared to residents in terms of organ allocation.However, in Poland, non-residents can only receive an organif a suitable Polish recipient does not exist. Similarly, in theUnited Kingdom, non-EU residents can receive a graft from adeceased donor only if there is no suitable national recipient.
It is encouraging, however, that in 85.7% of countries withrestrictions on access to transplantation for non-nationalsand non-residents, this does not apply to paediatric cases.Similarly, 66.6% of countries with restrictions on access totransplantation for non-nationals and non-resident individualswould consider enabling access to transplantation for suchindividuals in the case of a medical emergency associatedwith life-threatening conditions. In most of these cases,however, access to transplantation for such individuals isonly allowed if the life-threatening condition arose suddenlywhilst in the country.
TRANSPLANTATION FROM LIVING DONORS
With regard to organ transplantation from living donors, 80.7%of the respondent countries indicated that they would considerit even in cases where the living donor, the recipient or bothwere non-resident/non-national individuals (Figure 2).
It should be clarified, however, that in the vast majority ofcases, a thorough assessment of both the donor and recipientprofiles, including technical and non-technical aspects, wouldbe undertaken in advance. In addition, the financial aspectsof the procedures would also be closely analysed prior toproceeding with the transplant.
A familial relationship is required in all cases to perform livingdonor organ transplantation if the living donor, the recipientor both are non-resident/non-national, where this is allowed(Figure 3). However, 71.4% of these countries would alsoconsider living donor organ transplantation involving non-residents/non-nationals if a close emotional relationshipbetween donor and recipient existed.Figure 1. Access to cadaveric waiting lists for different patient categories
in European countries.
Figure 2. Countries that would consider organ transplantation usinga living donor even in the cases where the living donor, the recipientor both were non-resident/non-nationals.
European citizens,non-resident in a country,
having access to thecadaveric waiting list
Non-European citizens,non-resident in a country,
having access to thecadaveric waiting list
National residing abroad(who have lost their
resident status) havingaccess to the cadaveric
waiting list
Non-national, non residentindividuals paying for
their own medicaltreatments and havingaccess to the cadaveric
waiting list
Yes38.5%No
61.5%
Yes33.3%
No66.7%
Yes50%
No50%
Yes80.7%
No19.3%
Yes27%
No73%
87
The questionnaire also explored the provisions in place ineach country in case of acute graft failure following livingdonor organ transplantation and where the living donor, therecipient or both are non-resident/non-national. In 50% ofthe countries, recipients of an acutely failed graft from a livingdonor are legally entitled to have access to the national waitinglist; in another 10%, this would be possible only for a failedliver transplant, whilst in 5% access to the national waitinglist would be possible only if the recipient was otherwisequalified. In 35% of the countries, however, recipients of anacutely failed living donor graft, where the living donor, therecipient or both are non-resident/non-national, are notentitled to have access to the national waiting list.
Finally, the survey also explored whether, in a given country,non-nationals and non-resident patients could undergotransplantation from a living donor at his/her own expense.More than one third of the respondent countries stated that,even at their own expense, non-resident patients were notauthorised to undergo transplantation from a living donor.
HEALTH & SOCIAL ASSISTANCE
The questionnaire also looked into the financial coverage ofthe transplantation amongst the various categories ofindividuals in need of a transplant. As far as residents areconcerned, whilst cost coverage is guaranteed for all nationalsundergoing transplantation in their own country, this wasextended to residing aliens in only one third of the countries.As far as residing aliens, national non-residents, illegal aliensand asylum seekers the situation is summarised in Figure 4.
Interestingly, financial coverage is also provided to non-resident/non-nationals in 2 countries, a benefit that is alsoextended to non-EU citizen in one of these. Healthcareassistance rules for non-resident/non-nationals asking foradmission to deceased waiting lists do not differ in publicversus private hospitals in 77% of countries, whereas only23% of countries declared that transplantation takes placeexclusively in public institutions. The financial scheme reportedabove is independent of whether the transplant takes placein a private or public hospital.
CONCLUSIONS
This brief report highlights the significant degree of diversitywith regard to access to transplantation for non-resident/non-national patients in member states of the Council of Europe.Indeed, the spectrum of transplantation opportunities providedto non-resident/non-national citizens by European countriesgoes from granting rights similar to those reserved fornationals to denying access to transplantation.
However, it is encouraging to note that in many, but not allcountries, very specific circumstances, such as paediatrictransplantation, life-threatening emergencies and immediatefailure of a transplanted organ, may allow to by-pass the existingregulatory frameworks and grant access to transplantation topatients with special needs. It is anticipated that activities suchas those conducted and promoted by the CD-P-TO will beinstrumental to better appreciate the heterogeneity of theEuropean landscape with regard to transplantation, to identifypossible areas of intervention and to facilitate the transfer ofknow-how across Europe. Together, such efforts are expectedto contribute to the harmonisation of transplantation accessand practices across the member states of the Council of Europe.
Figure 3. Relationship required between donor and recipient in thecountries that perform living donor organ transplantations where theliving donor, the recipient or both are non-resident/non-nationals.
Figure 4. Financial coverage of the transplantation procedures fordifferent patient categories.
Relative oremotionally related
71.4%
Relativeonly
28.6%
Residingaliens
Yes30%No
70%
Yes47.8%No
52.2%
Nationalnon-residents
Illegalaliens
Yes30.4%No
69.6%
Yes65.2%
No34.8% Asylum
seekers
✍
European Committee (Partial Agreement)on Organ Transplantation (CD-P-TO)
ChairmanPFEFFER Per
MembersAUSTRIA
MUEHLBACHER FerdinandBELGIUM
COLENBIE LucMUYLLE Ludo (secondment)
BULGARIAGICHEVA Maria
CROATIABUSIC MirelaRALEY Lydia
CYPRUSHADJIANASTASSIOU Vassilis
CZECH REPUBLICBREZOVSKY Pavel
DENMARKCARLSEN Jorn
ESTONIADMITRIEV Peeter
FINLANDSALMELA Kaija
FRANCELAOUABDIA-SELLAMI KarimTHUONG Marie (secondment)LIFFRAN Geneviève (secondment)
GERMANYKIRSTE Günter (vice chair)TONJES Ralf Reinhard (secondment)
GREECEHATZIS AnastasiosGAKIS Dimitrios (secondment)
HUNGARYLANGER Robert
ICELANDMAGNUSSON Sveinn
IRELANDEGAN Jim
ITALYNANNI COSTA AlessandroCOZZI Emanuele (secondment)CHATZIXIROS Efstratios(secondment)
LATVIATRUSHKOV Sergey
LUXEMBURGJOME Laurent
MALTAZARB ADAMI Joseph
NETHERLANDSHAASE-KROMWIJK Bernadette
NORWAYOYEN Ole
POLANDDANIELEWICZ Roman
PORTUGALAMIL MargaridaBOLOTINHA Catarina
ROMANIAZOTA Victor
SLOVAK REPUBLICDANNINGER Filip
SLOVENIAAVSEC Danica
SPAINMATESANZ RafaelDOMINGUEZ-GIL Beatriz(secondment)MARAZUELA Rosario (secondment)
SWEDENMÖLLER CharlotteERICZON Bo-Göran (secondment)
SWITZERLANDMOREL Philippe
TURKEYKEMALOGLU BahriSEYHAN Türkay
UNITED KINGDOMNEUBERGER James
Observers
ARMENIASARKISSIAN Ashot
AZERBAIJANKADIROV Aydin Vali
BELARUSRUMO Aleh
CANADAAGBANYO Francisca
CDBI (BIOETHICS COMMITTEE,COUNCIL OF EUROPE)
GEFENAS Eugenijus HAËRTEL Ingo (secondment)
ESOT (EUROPEAN SOCIETY FORORGAN TRANSPLANTATION)
PLOEG RutgerEUROPEAN COMMISSION
LE-BORGNE HélèneSISKA Ioana-Raluca
EUROTRANSPLANT INTERNATIONALFOUNDATION
RAHMEL AxelOOSTERLEE Arie
GEORGIATOMADZE Gia
HOLY SEEMgr RALLO Vito
ISRAEL ASHKENAZI Tamar
MOLDOVACODREANU Igor
SCANDIATRANSPLANTHOCKERSTEDT Krister
TTS (THE TRANSPLANTATION SOCIETY)DELMONICO FrancisEKBERG Henrik
RUSSIAN FEDERATIONGABBASOVA LyalyaNIKOLAEV German
UKRAINENYKONENCO OleksandrSOBOKAR Vitaliy
UNOS (UNITED NETWORK FOR ORGANSHARING)
MYER KevinPRUETT Timothy
USAWITTEN Celia
WHO (WORLD HEALTH ORGANISATION)NOEL Luc
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