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Jansen NE, Williment C, Haase-Kromwijk BJJM, Gardiner D. Changing to an Opt Out System for Organ Donation—Reflections From England and Netherlands. Transpl Int 2022; 35:10466. [PMID: 35859668 PMCID: PMC9290126 DOI: 10.3389/ti.2022.10466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022]
Abstract
Recently England and Netherlands have changed their consent system from Opt In to Opt Out. The reflections shared in this paper give insight and may be helpful for other nation considering likewise. Strong support in England for the change in legislation led to Opt Out being introduced without requiring a vote in parliament in 2019. In Netherlands the bill passed by the smallest possible majority in 2018. Both countries implemented a public campaign to raise awareness. In England registration on the Donor Register is voluntary. Registration was required in Netherlands for all residents 18 years and older. For those not already on the register, letters were sent by the Dutch Government to ask individuals to register. If people did not respond they would be legally registered as having “no objection.” After implementation of Opt Out in England 42.3% is registered Opt In, 3.6% Opt Out, and 54.1% has no registration. In contrast in Netherlands the whole population is registered with 45% Opt In, 31% Opt Out and 24% “No Objection.” It is too soon to draw conclusions about the impact on the consent rate and number of resulting organ donors. However, the first signs are positive.
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Affiliation(s)
- N. E. Jansen
- Dutch Transplant Foundation, Leiden, Netherlands
- *Correspondence: N. E. Jansen,
| | - C. Williment
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | | | - D. Gardiner
- National Health Service Blood and Transplant, Bristol, United Kingdom
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de Vries APJ, Alwayn IPJ, Hoek RAS, van den Berg AP, Ultee FCW, Vogelaar SM, Haase-Kromwijk BJJM, Heemskerk MBA, Hemke AC, Nijboer WN, Schaefer BS, Kuiper MA, de Jonge J, van der Kaaij NP, Reinders MEJ. Immediate impact of COVID-19 on transplant activity in the Netherlands. Transpl Immunol 2020; 61:101304. [PMID: 32371150 PMCID: PMC7194049 DOI: 10.1016/j.trim.2020.101304] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
Abstract
The rapid emergence of the COVID-19 pandemic is unprecedented and poses an unparalleled obstacle in the sixty-five year history of organ transplantation. Worldwide, the delivery of transplant care is severely challenged by matters concerning - but not limited to - organ procurement, risk of SARS-CoV-2 transmission, screening strategies of donors and recipients, decisions to postpone or proceed with transplantation, the attributable risk of immunosuppression for COVID-19 and entrenched health care resources and capacity. The transplant community is faced with choosing a lesser of two evils: initiating immunosuppression and potentially accepting detrimental outcome when transplant recipients develop COVID-19 versus postponing transplantation and accepting associated waitlist mortality. Notably, prioritization of health care services for COVID-19 care raises concerns about allocation of resources to deliver care for transplant patients who might otherwise have excellent 1-year and 10-year survival rates. Children and young adults with end-stage organ disease in particular seem more disadvantaged by withholding transplantation because of capacity issues than from medical consequences of SARS-CoV-2. This report details the nationwide response of the Dutch transplant community to these issues and the immediate consequences for transplant activity. Worrisome, there was a significant decrease in organ donation numbers affecting all organ transplant services. In addition, there was a detrimental effect on transplantation numbers in children with end-organ failure. Ongoing efforts focus on mitigation of not only primary but also secondary harm of the pandemic and to find right definitions and momentum to restore the transplant programs.
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Affiliation(s)
- A P J de Vries
- Department of Internal Medicine, Division of Nephrology and Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
| | - I P J Alwayn
- Department of Surgery, Division of Transplant Surgery and Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
| | - R A S Hoek
- Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - A P van den Berg
- Department of Gastroenterology and Hepatology, University Hospital Groningen, Groningen, the Netherlands
| | - F C W Ultee
- Department of Nephrology and surgery/transplant coordination, Academic Medical Center, Amsterdam, the Netherlands
| | - S M Vogelaar
- Eurotransplant International, Leiden, the Netherlands
| | | | - M B A Heemskerk
- Dutch Transplant Foundation (DTF/NTS), Leiden, the Netherlands
| | - A C Hemke
- Dutch Transplant Foundation (DTF/NTS), Leiden, the Netherlands
| | - W N Nijboer
- Department of Surgery, Division of Transplant Surgery and Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
| | - B S Schaefer
- Dutch Transplant Foundation (DTF/NTS), Leiden, the Netherlands
| | - M A Kuiper
- Dutch Transplant Foundation (DTF/NTS), Leiden, the Netherlands.; Medical Center Leeuwarden, Department of Intensive care, Leeuwarden, the Netherlands
| | - J de Jonge
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Dutch Transplant Society (DTS/NTV), the Netherlands
| | - N P van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Dutch Transplant Society (DTS/NTV), the Netherlands
| | - M E J Reinders
- Department of Internal Medicine, Division of Nephrology and Transplant Center, Leiden University Medical Center, Leiden, the Netherlands; Dutch Transplant Society (DTS/NTV), the Netherlands.
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Haase-Kromwijk BJJM, Heemskerk MBA, Weimar W, Berger SP, Hoitsma AJ. [Waiting list registration for kidney transplants must improve]. Ned Tijdschr Geneeskd 2017; 161:D812. [PMID: 28378695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate how the composition of the waiting list for postmortem kidney transplant has developed, and whether the waiting list reflects actual demand. DESIGN Retrospective research and cohort study. METHOD We used data from the period 2000-2014 from the Dutch Transplant Foundation, 'RENINE' and Eurotransplant. This concerned data on postmortem kidney donation, live donor transplants, the waiting list and kidney transplantation. RESULTS The postmortem kidney transplant waiting list included transplantable (T) and non-transplantable (NT) patients. The number of T-patients declined from 1271 in 2000 to 650 in 2014, and the median waiting time between the start of dialysis and postmortem kidney transplant decreased from 4.1 years in 2006 to 3.1 years in 2014. The total number of patients on the waiting list, however, increased from 2263 in 2000 to 2560 in 2014 and in the same period the number of new patient registrations increased from 772 to 1212. In about 80% of the NT-patients the reason for their NT status was not registered. A cohort analysis showed that NT-patients have a 2-times lower chance of a postmortem kidney transplant and a 2-times higher chance of leaving the waiting list without transplantation or of live-donor transplantation. CONCLUSION The demand for donor kidneys remains high. The increased number of transplants resulted in a declining waiting list for T-patients while the total waiting list is getting longer. Waiting list registration and maintenance need to be improved, to give better insight into the real demand.
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Jansen NE, van Leiden HA, Haase-Kromwijk BJJM, Hoitsma AJ. Organ donation performance in the Netherlands 2005-08; medical record review in 64 hospitals. Nephrol Dial Transplant 2010; 25:1992-7. [DOI: 10.1093/ndt/gfp705] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jansen NE, van Leiden HA, Sieber-Rasch MH, Hoitsma AJ, Haase-Kromwijk BJJM. [More potential organ donors than actual donations in 52 intensive-care units in the Netherlands, 2001-2004]. Ned Tijdschr Geneeskd 2007; 151:696-701. [PMID: 17447597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To assess the number of potential organ donors and the main reasons why organ donation is not performed. DESIGN Retrospective. METHOD The number of potential heart-beating (HB) and non-heart-beating (NHB) donors was assessed by reviewing the medical records of 588o patients who died between 2001 and 2004 in 52 intensive-care units (ICUs) in 30 hospitals. The number of actual donations was also assessed. RESULTS The potential of HB donors was 2.5 to possibly 6.6% of all ICU deaths and HB donation was performed in 1.9% of all ICU deaths. The potential of NHB donors of category III was at least 4.2% of all ICU deaths and NHB donation was performed in 1.0% of all ICU deaths. The main difficulty in the donation process was objection from family members, which was reported in 45% of all potential HB and NHB donors and in 59% of all donation requests to relatives. Of the potential HB and NHB donors 7.3% were not identified as potential donors. CONCLUSION These results confirm that organ-donor potential is greater than the number of actual donations. Objection from family members is the main limiting factor.
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Affiliation(s)
- N E Jansen
- Nederlandse Transplantatie Stichting, Postbus 2304, 2301 CH Leiden.
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de Klerk M, Haase-Kromwijk BJJM, Witvliet M, Claas FHJ, Weimar W. [Favourable results of the first 2 years of the Dutch paired, living donor, kidney exchange programme]. Ned Tijdschr Geneeskd 2007; 151:130-3. [PMID: 17315491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To assess the results of the paired, living donor, kidney exchange protocol in the Netherlands. DESIGN Descriptive. METHODS In January 2004, all 7 Dutch kidney transplantation centres implemented a paired, living donor, kidney exchange protocol for donor-recipient combinations in which direct kidney transplantation is not possible. The Dutch Transplantation Foundation is responsible for the allocation, in which new donor-recipient combinations are created in accordance with four allocation criteria: blood group, match probability, time on the waiting list, and age difference between the donors. The results of the first 2 years of this programme have now been assessed. RESULTS From January 2004 until December 2005, the national programme registered a total of 116 donor-recipient combinations, including 62 blood type incompatible pairs and 54 positive cross-match pairs. In 8 matching procedures, 58 newly created donor-recipient combinations had negative cross matches. 49 patients (42%) were transplanted. CONCLUSION The Dutch living donor exchange programme for kidney transplantation appears to be very successful, with 42% effective transplantations in the first 2 years.
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Affiliation(s)
- M de Klerk
- Erasmus MC, afd. Inwendige Geneeskunde, sectie Transplantatie, Kamer D 408, Postbus 2040, 3000 CA Rotterdam.
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de Klerk M, Haase-Kromwijk BJJM, Claas FHJ, Witvliet M, Weimar W. Living Donor Kidney Exchange for Both ABO-Incompatible and Crossmatch Positive Donor–Recipient Combinations. Transplant Proc 2006; 38:2793-5. [PMID: 17112831 DOI: 10.1016/j.transproceed.2006.08.157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Strategies to decrease the wait time for kidney transplantation include the use of living donor kidneys. However, it is not always possible to donate directly, due to ABO blood type incompatibility or a positive crossmatch. Therefore, other options were explored, including a program for living donor kidney exchange. METHODS All Dutch kidney transplantation centers agreed on a common donor kidney exchange protocol. The Dutch Transplantation Foundation is responsible for the allocation, crossmatches are centrally performed, and exchanges take place on an anonymous basis. Donors travel to the recipient centers. Surgical procedures are simultaneously scheduled. RESULTS From January 2004, we registered in total 116 combinations consisting of blood type-incompatible pairs (n = 62) and positive crossmatch pairs (n = 54). In eight match procedures we created 58 new donor-recipient combinations with negative crossmatches, including six triplets and 20 doublets. It proved to be significantly (P = .0014) less difficult to find a solution for the crossmatch-positive combinations than for the blood type-incompatible combinations (67% vs 35%). CONCLUSION The Dutch national living donor kidney exchange program resulted in a 50% success rate. Combining blood type-incompatible and crossmatch-positive donor-recipient pairs in one program is a realistic option for all blood type combinations.
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Affiliation(s)
- M de Klerk
- Department of Internal Medicine-Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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Abstract
The shortage of kidneys from brain-dead donors for transplantation has made it necessary to look for alternatives. Living kidney donation is one possibility. However, because of ABO blood group incompatibility or immunological reasons, transplantation of kidneys from a living donor is not always possible. The seven Dutch kidney transplantation centers have developed a joint protocol for crossover, or paired donor exchange, kidney transplantation. To ensure a fair chance for all participating donor-recipient pairs, the Dutch Transplantation Foundation has developed an allocation algorithm to match compatible donor-recipient pairs. A crossover match is performed every 3 months. The computer program developed by the Dutch Transplantation Foundation to match compatible donor-recipient pairs calculates the match probability (MP) of every potential recipient. The MP takes into account the peak panel-reactive antibodies (%PRA) of the recipient, the incidence within the crossover donor population of (compatible) ABO blood group, and HLA unacceptables of the recipient. The potential recipient with the lowest MP, in other words, the recipient with the smallest chance of finding a compatible donor in the pool, is ranked first. Until now, three matches have been performed in the Netherlands. A total of 53 pairs from all seven Dutch transplantation centers have participated. For 22 of the pairs a compatible donor-recipient pair was found.
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Affiliation(s)
- K M Keizer
- Dutch Transplantation Foundation, Erasmus Medical Center, Rotterdam, The Netherlands.
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