Challenges in kidney transplantation faced by Europe: what can be done?

By Prof Raymond Vanholder, Belgium, EKHA Chairman

 

   

Prof. Vanholder briefly outlined a number of challenges related to living and deceased donations and pointed measures to boost organ donation rates in Europe.

There is a number of patients who albeit have a good life expectatios, are not put on the kidney transplantation waiting list one year or more after their ESRD onset e.g : approx. one-third of ESRD patients are not listed for transplantation within one year, with less than 5 years projected life on dialysis). It is thus important, to ensure more of these patients are enlisted in a timely manner.

  • To boost donation rates, donors need to be supported as to the cost incurred and their loss in income.
  • It is also important to encourage not only spouse living donation but also donation from unrelated people.
  • Uniform procedures for donor information and recruitment (guidelines) should be defined and applied.
  • Based on evidence, donor and acceptor selection criteria shall be reviewed and relaxed as appropriate
  • There should be reimbursement consideration for families of donors (hospital or funeral costs)
  • Donor registration should be stimulated and simplified.
  • Donation should be formally recognized.

Looking at opting-in vs. opting-out systems, Prof Vanholder clearly outlined, based on results of studies, that presumed consent enhances cadaveric donation and that opting out systems increases transplantation rates. The number of deceased donations is growing but this is partly compensated by the reduction in living donations. He invited the EU to move into the direction of cooperation on this matter.

As for expanded-criteria donors  (e.g older kidney donors (≥60 yr) or donors aged 50 to 59 yr having two of the following three features: Hypertension, terminal serum creatinine >1.5 mg/dl, or death from cerebrovascular accident), Prof Vanholder outlined that survival chances are worse for expanded donation and mentioned that although these may help, there is room to create evidence base and guidance is need as regarded selection criteria.

A big potential lies into increased patient information and education: a study showed that patient education on transplantation is better than for other modalities (in center dialysis, home dialysis, selfcare haemodialysis, peritoneal dialysis) but results are still not brilliant.

The results of EKHA’s treatment choice questionnaire in 9 European countries made to patients, professionals further showed that there is disharmony in Member States: while in most countries, information about kidney donation is given, the options between living and deceased donations are often not equally discussed.

Download Professor Raymond Vanholder presentation slides here.