TABLE 1.
Informal European survey of practices regarding transplantation, 2021.
| Country or organization for deceased donor allocation | Population (million) | Living donation | Deceased donation | |||
|---|---|---|---|---|---|---|
| Is there access to a kidney exchange program? | Does the allocation scheme include prioritization for sensitized recipients? | Does the allocation scheme include an acceptable mismatch program? | Details | |||
| Eurotransplant (Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, Netherlands, Slovenia) | 137 | Yes: Austria (with the Czechia and Israel), Belgium (20), Netherlands | Yes | Yes | Acceptable antigens are defined by the lack of antibody-reactivity in complement-dependent cytotoxicity assays using target cells mismatched for a single HLA antigen, or single antigen-expressing cell lines | |
| ScandiaTransplant (Denmark, Finland, Iceland, Norway, Sweden, Estonia) | 28.9 | ScandiaTransplant Kidney Exchange Program launched April 2019 | Yes | Yes, ScandiaTransplant Acceptable Mismatch Program (STAMP) a | Common waiting list and database system. STAMP patients have the highest priority for a deceased donor kidney | |
| Czechia | 10.7 | Yes | Yes | No | Patients are categorized according to their measured PRA: 0%–20%, 20%–80, and >80%, with higher priority for transplantation given to those with higher PRA values. Patients who have waited longer than 3 years for a transplant are prioritized, regardless of their PRA value | |
| Recent expansion to include Austria and Israel | DSA are allowed, based on local protocols for desensitization | |||||
| France | 67 | Yes | Yes | Yes | Sensitized patients are prioritized according to waiting time and HLA compatibility | |
| Greece | 10.4 | Yes | Yes | Yes | Patients are prioritized based on waiting time and HLA mismatch | |
| Ireland | 5 | Yes—with the United Kingdom | Yes | Yes | All highly sensitized patients who are long waiting are screened to identify acceptable mismatches or windows in which they can be transplanted | |
| Italy | 60.3 | Yes | Yes | Yes | The Italian national allocation scheme prioritizes at national level patients with PRA >90% and who have been on dialysis >8 years | |
| Recipients are selected according to a points score, based on | ||||||
| - PRA | ||||||
| - Age mismatch between donor and recipient | ||||||
| - Recipient age | ||||||
| - HLA mismatch | ||||||
| - Time spent on dialysis | ||||||
| - Time on waiting list | ||||||
| Latvia | 1.9 | Yes (21) | ||||
| Lithuania | 2.9 | Yes (22) established in 2013, although up to 2019, the system has not been used | Although Lithuania is not a member of international organ procurement and allocation organizations yet, they do collaborate with neighboring Nordic countries and exchange organs with Latvia, Estonia and Poland | |||
| Poland | 38 | Yes | Yes | Yes | Prioritization for patients with a PRA >80%; increased weighting for patients with PRA 50–79 | |
| Portugal | 10.2 | Yes | Yes | No | Additional points for sensitized and highly sensitized patients | |
| Russia | 146.2 | NoEach transplant center has their own internal protocol | YesSome kidney centers may transplant if there is an acceptable mismatch | There is no common waiting list in Russia or any kind of program like Eurotransplant. Each center has its own waiting list, their own algorithm for prioritizing patients for transplantation (although many use UNOS, Intermax or other classification systems to help decisions) and their own protocol for post-transplant follow-up | ||
| Prioritization is based on donor and recipient risk index match, waiting time, and HLA mismatch | ||||||
| Slovakia | 5.4 | No | No | No | ||
| Spain | 46.8 | Yes | Yes | No | One kidney of all brain death donors is offered to a National Prioritization Scheme for sensitized patients with a cPRA >98%. Kidney acceptance for an individual patient based on virtual crossmatch (23) | |
| Switzerland | 8.74 | Yes | Yes | Yes | Prioritization for allocation is based on a continuum of increasing cPRA for each blood group. An MFI cut-off of 1,000 is used for both class 1 and class 2 DSA | |
| Turkey | 85.6 | Yes | No | No | Allocation is according to a scoring system | |
| Criteria | Score | |||||
| HLA match | DR 150, B 50, A 5 | |||||
| Region | 1000 | |||||
| Center | 250 | |||||
| Recipient age (<11 years / 12–17/≥18 years | HLA match score multiplied by 2.5/1.5/1 | |||||
| Time on dialysis | 3 points for each month | |||||
| United Kingdom | 68 | Yes | Yes | No | Absolute priority for those with cRF >100%, matchability score 10, waiting time >7 years | |
| Remaining patients prioritized on points score, based on | ||||||
| i. Donor and recipient risk index match | ||||||
| ii. Waiting time | ||||||
| iii. HLA mismatch | ||||||
| iv. Local region > non-local regions (of four national regions) | ||||||