Allocation of donor organs
The NTS is legally responsible for the 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 system for organ allocation 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 accounted for and verifiable.
- Valid: based on widely supported medical and ethical criteria.
Allocation is fundamentally based on two principles:
- The expected transplant outcome.
- The urgency, determined by experts in an objective and transparent manner.
In addition, consideration is given to waiting time, the national organ balance (fair exchange between countries), and logistical feasibility.
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 group, and tissue typing are important for allocation.
Pancreas
Allocation of the pancreas is often done in combination with a kidney (pancreas-kidney transplantation).
Liver
Patients on the liver waitlist receive a reMELD-Na score (0 to 36). In case of acute liver failure, someone may receive priority.
ReMELD-Na score
Eurotransplant uses the reMELD-Na score to determine the mortality risk of patients on the waitlist for a liver transplantation. This is an adjusted score specifically for the Eurotransplant countries. This differs from the international (UNOS) MELD-Na score. Use the calculator on the Eurotransplant website to calculate the reMELD-Na score.
- To calculator on Eurotransplant.nl
- ET guideline for liver allocation
- Explanation for liver waitlist patients
Heart
Heart patients can receive (inter)national priority via the HU status (High Urgent).
Lungs
Patients over the age of 12 receive a Lung Allocation Score, the LAS score (0 to 100). Children under the age of 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 nationally and internationally?
The Dutch Transplant Foundation (NTS) ensures that allocation follows medical rules and that every patient on the waitlist has a fair chance of receiving a donor organ.
The NTS has mandated the allocation of organs to Eurotransplant (ET), a collaborative partnership of 8 European countries. Together with Eurotransplant, organ advisory committees, physicians, and transplant centers, we ensure that as many patients as possible receive a donor organ on time.
Eurotransplant
On behalf of the NTS, Eurotransplant handles the practical allocation of donor organs within the 8 European countries. The allocation rules are established nationally and executed internationally via Eurotransplant. Eurotransplant is responsible for:
- Management of the central registration system for waitlists and donor registrations.
- Allocating organs according to national and international rules.
- Optimization through data analysis and proposals for improvement.
New insights from the analysis of Eurotransplant data can lead to recommendations for adjusting the 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.
Role of OACs:
- Establishing and adjusting medical allocation rules.
- Evaluating 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