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CAPE ORGAN ALLOCATION POLICY

CAPE ORGAN ALLOCATION POLICY. Fiona McCurdie 4 th SATS Controversies Meeting May 2011. CURRENT SYSTEM. Initiated in 2001 following meetings and extensive discussion and consultation between 4 transplant centres - has generally worked well - needs to be reassessed.

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CAPE ORGAN ALLOCATION POLICY

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  1. CAPE ORGAN ALLOCATION POLICY Fiona McCurdie 4th SATS Controversies Meeting May 2011

  2. CURRENT SYSTEM Initiated in 2001 following meetings and extensive discussion and consultation between 4 transplant centres - has generally worked well - needs to be reassessed

  3. Transplant Centres Involved • CBMH - private recipients from W Cape, E Cape, N Cape • GSH / RXH - state recipients from W Cape, E Cape, N Cape (Paed – KZN) - private recipients from W Cape, E Cape, N Cape • TBH - state recipients from W Cape

  4. Aims of allocation system • To achieve the best result in terms of graft and patient and graft outcome • Produce a fair and equitable sharing of the scarce resource • User friendly

  5. Priorities used - • ABO matching • HLA match • PRA • Donor of <12yrs - kidneys allocated to paediatric recipient (<14yrs)

  6. Allocation of “Local”/W Cape Kidneys • 1st Kidney - donor / harvesting team • 2nd Kidney – pool kidney Allocated by following criteria - ABO Grp (never O to A, B, AB) - Length of time waiting - HLA matching - PRA - Paediatric to paediatric

  7. Allocation of “Out of Town”/NCape and ECape Kidneys • Ist Kidney –patient from the region supplying the kidneys • 2nd Kidney – harvesting team/ W Cape choice then - another patient from supplier region then - patient from general pool

  8. Practical Points • Date of tissue typing defines length of time on waiting list • Allocating person is from original “donor team” • Pool kidney allocated to a patient not a unit • If first pool patient is not well/ unavailable, kidney gets allocated to next pool patient on list. Not another patient from same unit

  9. Current Situation / Issues • Harvesting team not always from centre donor originally referred to – potential confusion/ conflict • Length of cold ischaemic time can influence allocation (E Cape / N Cape / W Cape flight availability and timing) • E Cape requesting to be part of general pool • NHBD programme only at GSH – kidneys remain at GSH • Consensus needed on definition of “paediatric” with respect to donor age, recipient age and priority status

  10. Plans • Meeting planned for 27 May - reps from all regions attending • Variety of issues – - Review of current system - Allocation options - Criteria for list - Public /Private - Increased Tissue Typing Lab involvement - Contributions vs benefit

  11. “A work in progress”

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