Impact of change in the United Kingdom pediatric donor organ allocation policy for intestinal transplantation.
BACKGROUND
Graft availability remains a problem in pediatric intestinal transplantation (IT), with most children waiting being less than 10 kg weight. In November 2004, wait-listed children in the United Kingdom were prioritized nationally to receive pediatric donor organs to improve donor availability for IT. We aimed to evaluate the impact of this change on the recipient population.


METHODS
Data regarding pediatric donor organ availability and allocation were accessed from the National Transplant database. Recipient demographics and outcomes were recorded from the Liver Unit database. Between 2001 and 2006, there were 228 pediatric donors in the United Kingdom (nonheart-beating donors were excluded), of which 39 livers were allocated to emergency super-urgent liver candidates. A total of six isolated intestine and 21 liver-intestine transplants (15 reduced size, six full grafts) were performed in the same period.


RESULTS
Since January 2001, there has been a progressive reduction in overall pediatric organ donation. Increasing awareness about IT has resulted in a significant increase in number of small bowel organs being offered (71.8% vs. 19.5%), although this has been associated with an increase in referrals for transplantation. Despite an increase in number of IT being performed (2.6 vs. 7.7 mean transplants per year), waiting list mortality still remains high in smaller children (<10 kg weight). No mortality was observed in larger children and in candidates for isolated IT.


CONCLUSIONS
The new prioritization of the national pediatric donor allocation favoring IT has resulted in an increased number of procedures, without an impact on waiting list mortality for small children.
Giovanelli
Mara
M
Liver Unit, Birmingham Children's Hospital, Birmingham, United Kingdom.
Gupte
Girish L
GL
McKiernan
Patrick
P
Pocock
Phil
P
Beath
Susan V
SV
Lloyd
Carla
C
Sharif
Khalid
K
Mayer
David A
DA
Mirza
Darius F
DF
D001835:Body Weight; D002102:Cadaver; D002648:Child; D006291:Health Policy; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D016031:Liver Transplantation / Q000706:statistics & numerical data; D040841:Resource Allocation; D014019:Tissue Donors / Q000706:statistics & numerical data*; D020858:Tissue and Organ Harvesting / Q000379:methods; D014184:Transplantation, Homologous / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D014850:Waiting Lists