title: Expanding the donor pool to increase renal transplantation.
abstract: BACKGROUND
  The goal of the Eurotransplant renal allocation scheme is to provide every patient on the waiting list with a reasonably balanced opportunity for a donor offer. New initiatives were taken in order to maximize donor usage while maintaining a successful transplant outcome.
  
  
  METHODS
  Two Eurotransplant projects were launched in order to accommodate changes in donor and recipient profiles. A re-addressing of the non-heart-beating donor pool was undertaken and an allocation scheme in which organs from donors aged >65 are allocated to recipients aged >65 [the Eurotransplant Senior Programme (ESP)] was introduced.
  
  
  RESULTS
  Especially in The Netherlands, an enormous increase in the number of non-heart-beating donor kidneys has been observed, however with a pace-keeping reduction in heart-beating donors. The organization-wide implementation of the ESP has been successful. The 3 year graft survival rates for these age-matched transplants were as good as the human leukocyte antigen (HLA)-matched transplants (64 vs 67%) (P = 0.4).
  
  
  CONCLUSIONS
  Within the framework of sound research, the utmost flexibility and creativity is needed to keep or even increase the number of renal transplants when faced with a quantitatively stagnating but qualitatively deteriorating donor pool. Both the non-heart-beating donor protocol and the ESP have proven to be quite successful in achieving this goal without compromising the outcome for the individual end-stage renal disease patient.
authors.affiliation: Eurotransplant International Foundation, Leiden, The Netherlands. bcohen@eurotransplant.nl
authors.forename: Bernard
authors.initials: B
authors.lastname: Cohen
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Smits
authors.forename: Bernadette
authors.initials: B
authors.lastname: Haase
authors.forename: Guido
authors.initials: G
authors.lastname: Persijn
authors.forename: Yves
authors.initials: Y
authors.lastname: Vanrenterghem
authors.forename: Ulrich
authors.initials: U
authors.lastname: Frei
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D005858:Germany; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016730:Program Development; D015397:Program Evaluation; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000458:organization & administration*