Allocation of donor organs
The NTS is legally responsible for a careful, fair, and transparent allocation of available donor organs to people on the waiting list. Read how this works and view the allocation guidelines.
Allocation of donor organs
The organ allocation system is:
- Objective: the match list is the same for everyone, regardless of who performs the allocation.
- Reproducible: the same medical situation leads to the same outcome.
- Transparent: every step in the process is accountable and verifiable.
- Valid: based on widely supported medical and ethical criteria.
The allocation is fundamentally based on two principles:
- The expected transplant outcome.
- The urgency, determined by experts in an objective and transparent manner.
In addition, waiting time, the national organ balance (fair exchange between countries), and logistical feasibility are also taken into account.
Allocation guidelines per organ
The rules for organ allocation are laid down in Eurotransplant guidelines. View per organ:
- Organ-specific allocation guidelines on the Eurotransplant website
- Patient information.
Kidney
Factors such as dialysis time, blood type, and tissue typing are important for allocation.
Pancreas
Allocation of the pancreas often occurs in combination with a kidney (pancreas-kidney transplantation).
Liver
Patients on the liver waiting list receive a reMELD-Na score (0 to 36). In cases of acute liver failure, a patient may be given priority.
reMELD-Na score
Eurotransplant uses the reMELD-Na score to determine the mortality risk of patients on the waiting list for a liver transplant. This is an adjusted score specifically for the Eurotransplant countries. It differs from the international (UNOS) MELD-Na score. Use the calculator on the Eurotransplant website to calculate the reMELD-Na score.
- Go to calculator on Eurotransplant.nl
- ET liver allocation guideline
- Explanation for liver waiting list patients
Heart
Heart patients can receive (inter)national priority via the HU (High Urgency) status.
Lungs
Patients over 12 years of age receive a Lung Allocation Score, the LAS score (0 to 100). Children under 12 automatically receive an LAS score of 100.
Small intestine
Small intestine transplantation is rare, occurring only in patients with severe intestinal failure and complications from parenteral nutrition.
Who is involved (inter)nationally?
The Dutch Transplant Foundation (NTS) ensures that allocation is carried out according to medical rules and that every patient on the waiting list has a fair chance of receiving a donor organ.
The NTS has mandated the allocation of organs to Eurotransplant (ET), a partnership of 8 European countries. Together with Eurotransplant, organ advisory committees, doctors, and transplant centers, we ensure that as many patients as possible receive a donor organ in time.
Eurotransplant
On behalf of the NTS, Eurotransplant carries out the practical allocation of donor organs within the 8 European countries. The allocation rules are determined nationally and implemented internationally via Eurotransplant. Eurotransplant is responsible for:
- Management of the central registration system for waiting lists and donor notifications.
- Allocating organs according to (inter)national rules.
- Optimization through data analysis and proposals for improvement.
New insights from the analysis of Eurotransplant data can lead to recommendations for adjusting allocation rules. These proposals are submitted to the organ advisory committees in the participating countries. They determine if and how the rules are adjusted – sometimes internationally, sometimes only nationally.
Video: allocation at Eurotransplant
Josipa Penic is an allocation officer and team leader at Eurotransplant. She provides an insight into her work.
National organ advisory committees
Organ advisory committees (OACs) of the Dutch Transplantation Society (NTV) consist of medical specialists. They play a crucial role in the fair and transparent allocation of organs and the best outcomes for patients.
Task of OACs:
- Establishing and adjusting medical allocation rules.
- Assessing international and national proposals for improvement.
The algorithms for organ allocation are complex and constantly evolving. They are based on medical data, ethical considerations, and logistical factors.
More about the committees on ntv.nl