EUROTRANSPLANT INTERNATIONAL FOUNDATION. Annual Report

Transcription

1 EUROTRANSPLANT INTERNATIONAL FOUNDATION Annual Report 2003

2 EUROTRANSPLANT INTERNATIONAL FOUNDATION 2003 LEGALLY FOUNDED: MAY 12, 1969 Edted by Bernard Cohen, Gudo G. Persjn Central offce P.O. box CH Leden The Netherlands Tel Fax All rghts reserved. No part of ths publcaton may be reproduced, stored n a retreval system or transmtted, n any form or by any means, electronnc, mechancal, photocopyng or otherwse, wthout pror permsson.

3 CIP-GEGEVENS KONINKLIJKE BIBLIOTHEEK, DEN HAAG Annual Annual Report/Eurotransplant Internatonal Foundaton. Leden: Eurotransplant Foundaton. -III., graf., tab. Verschjnt jaarljks Annual report 2002 / ed. by Bernard Cohen and Gudo G. Persjn ISBN Trefw.: Eurotransplant Foundaton; jaarverslagen. 2

4 TABLE OF CONTENTS Board of Eurotransplant Internatonal Foundaton 5 TRANSPLANT AND THEIR DELEGATES IN Renal Programs 6 Heart Programs 7 Lung Programs 8 Lver Programs 9 Pancreas (*Islet) Programs 10 Tssue Typng Laboratores 10 Foreword Report of the Board and the central offce of Stchtng Eurotransplant Internatonal Foundaton General Polcy Central offce Advsory Commttees Recommendatons approved Eurotransplant: donaton, watng lst and transplants n Table 2.1 Number of cadaverc organ donors, from the Eurotransplant regon and used for a transplant from 1999 to Table 2.2 Number of cadaverc organ donors, from the Eurotransplant regon and used for a transplant, by organ from 1999 to Table 2.3 Demographc data on cadaverc organ donors, from the Eurotransplant regon and used for a transplant from 1999 to Table 2.4a Type of cadaverc organ donaton, used n a transplant, from 1999 to Table 2.4b Type of cadaverc organ donaton, used n a transplant, by country of donor orgn for Table 2.4c Non-heart beatng donors Table 2.5 Sze of the actve Eurotransplant watng lst, by organ, as per December 31, from 1999 to Table 2.6 Regstratons on the Eurotransplant watng lst, by organ from 1999 to Table 2.7 Number of transplanted organs wthn Eurotransplant area, by organ, by donor type from 1999 to Table 2.8 Transplants n the Eurotransplant regon, from 1999 to Table 2.9 Mortalty on the Eurotransplant Watng Lst, from 1999 to Kdney: donaton, watng lsts, and transplants 31 Table 3.1 Cadaverc donor kdneys n the Eurotransplant regon n Table 3.2 Actve cadaverc kdney transplant watng lst as per December 31, characterstcs 31 Table 3.3 Actve cadaverc kdney transplant watng lst as per December 31, characterstcs 31 Table 3.4 Kdney transplants characterstcs Fgure 3.1 Dynamcs of the Eurotransplant kdney transplant watng lst and transplants between 1969 and Table 3.5 Lvng donor kdney transplants - kds only Thoracc organs: donaton, watng lsts, and transplants 34 Table 4.1 Cadaverc donor hearts n the Eurotransplant regon n Table 4.2 Cadaverc donor lungs n the Eurotransplant regon n

5 Table 4.3 Actve cadaverc heart transplant watng lst as per December 31, characterstcs 34 Table 4.4 Actve cadaverc heart transplant watng lst as per December 31, characterstcs 35 Table 4.5 Actve heart + lung transplant watng lst as per December 31, characterstcs 35 Table 4.6 Actve cadaverc heart + lung transplant watng lst as per December 31, characterstcs 35 Fgure 4.1 Dynamcs of the Eurotransplant heart watng lst and transplants betweeen 1991 and Table 4.7 Actve lung transplant watng lst as per December 31, characterstcs 36 Table 4.8 Actve cadaverc lung transplant watng lst as per December 31, characterstcs 36 Table 4.9 Heart transplants characterstcs 36 Table 4.10 Heart + lung transplants characterstcs 37 Fgure 4.2 Dynamcs of the Eurotransplant heart + lung watng lst and heart + lung transplants and Eurotransplant lung watng lst and lung transplants between 1991 and Table 4.11 Lung transplants characterstc Lver: donaton, watng lsts, and transplants 39 Table 5.1 Cadaverc donor lvers n the Eurotransplant regon n Table 5.2 Actve cadaverc lver transplant watng lst as per December 31, characterstcs 39 Table 5.3 Actve cadaverc lver transplant watng lst as per December 31, characterstcs 40 Table 5.4 Lver transplants characterstcs 40 Table 5.5 Lvng donor lver transplants - lver only Intestne transplants 41 Fgure 5.1 Dynamcs of the Eurotransplant lver watng lst and lver transplants between 1991 and Pancreas: donaton, watng lsts, and transplants 42 Table 6.1 Cadaverc donor pancreas n the Eurotransplant regon n Table 6.2 Actve cadaverc pancreas transplant watng lst as per December 31, characterstcs 42 Table 6.3a Actve cadaverc pancreas only transplant watng lst as per December 31, characterstcs 42 Table 6.3b Actve cadaverc kdney+pancreas transplant watng lst as per December 31, characterstcs 43 Table 6.4a Pancreas transplants characterstcs 43 Table 6.4b Number of pancreas slet transplantatons Table 6.4c Pancreas transplants characterstcs 44 Fgure 6.1 Dynamcs of the Eurotransplant pancreas + kdney and slet + kdney watng lst, pancreas + kdney, slet + kdney, pancreas and slet-only transplants between 1991 and Hstocompatblty Testng Introducton Eurotransplant External Profcency Testng (EPT) Schemes External Profcency Testng on HLA typng External Profcency Testng Exercses on molecular typng External Profcency Testng on Crossmatchng External Profcency Testng Exercse on Screenng Programmes for the hghly senstsed patents n Eurotransplant Other actvtes 47 Fgure 7.1. Transplanted AM patents 47 Fgure 7.2. Patents n the AM watng lst per Publcatons n Publcatons Abbrevated Fnancal Statements 50 4

6 Board of Eurotransplant Internatonal Foundaton as per December 31, 2003 Prof.Dr. Y.F.C. Vanrenterghem, Leuven Prof.Dr. A.P.W.P. van Montfort, Amstelveen Prof.Dr. U. Fre, Berln Prof.Dr. J.P. van Hooff, Maastrcht Prof.Dr. G. Laufer, Innsbruck Dr. B. Meser, Munch Prof.Dr. W. Bechsten, Frankfurt Prof.Dr. J.P.M. Lerut, Brussels (LA) Prof.Dr. W. Mayr, Venna Dr. J. Mytlneos, Ulm Prof.Dr. P. Schotsmans, Leuven Prof.Dr. F. Mühlbacher, Venna Prof.Dr. J. Vanhaecke, Leuven Dr. J.W. de Fjter, Leden Prof.Dr. J. Hauss, Lepzg Dr. J. Vonc na, Ljubljana Prof.Dr. F.H.J. Claas, Leden presdent (A) secretary / treasurer (D) vce-presdent + on behalf of the kdney / pancreas secton (A) on behalf of the kdney / pancreas secton (A) on behalf of the thoracc secton (A) on behalf of the thoracc secton (A) on behalf of the lver secton (A) on behalf of the lver secton (A) on behalf of the tssue typng secton (A) on behalf of the tssue typng secton (A) ethcal advsor (D) on behalf of the Austran Transplant Socety (B) on behalf of the Belgan Transplant Socety (B) on behalf of the Dutch Transplant Socety (B) on behalf of the German Transplant Socety (B) on behalf of the Slovenan Transplant Socety (B) on behalf of the Eurotransplant Reference Laboratory (C) The Board of Stchtng Eurotransplant Internatonal Foundaton conssts of: 9 members A: members representng organ / tssue typng sectons 5 members B: members representng natonal transplant socetes 1 member C: head of the Eurotransplant Reference Laboratory 2 members D: one member beng fnancal expert, one member representng socety (ethcst) 5

7 TRANSPLANT PROGRAMS AND THEIR DELEGATES IN 2003 Defntons (accordng to Artcles of Assocaton of Stchtng Eurotransplant Internatonal Foundaton, verson November 6, 2002) Program: Any of the followng transplantaton areas: kdney, thoracc organs, lver, tssue typng, pancreas and slets, whch have the approval of the competent and relevant authortes. (Artcle 2) Delegate: Each center shall have the rght to delegate one natural person n the Assembly for each program n whch t performed transplantatons durng a year. On each reference date, the number of persons delegated (the delegates ) by a center n the Assembly shall be revewed. (Artcle 5.1) (If left open: no delegate apponted by transplant/tssue typng program or new program n 2003.) RENAL PROGRAMS DELEGATE Austra GA Medznsche Unverstätsklnk, Graz IB Chrurgsche Unverstätsklnk, Innsbruck C. Bösmüller OE Krankenhaus der Elsabethnen, Lnz H.-K. Stummvoll OL Allgemenes Krankenhaus, Lnz G. Besenbach WG Unverstätsklnk für Chrurge, Wen F. Mühlbacher Belgum AN Unverstar Zekenhus Antwerpen, Edegem D. Ysebaert BJ Academsch Zekenhus der Vrje Unverstet, Brussel J. Sennesael BR ULB, Hôptal Erasme, Bruxelles K. Wssng LA Clnques Unverstares St. Luc, Bruxelles J.-P. Squfflet GE Unverstar Zekenhus, Gent P. Peeters LE Knderdalyse Unverstar Zekenhus Gasthusberg, Leuven R. Van Damme-Lombaerts LM Unverstar Zekenhus Gasthusberg, Leuven Y. Vanrenterghem LG Centre Hosptaler Unverstare, Lège Germany AK Unverstätsklnkum der Rhensch-Westfälschen TH, Aachen A. Homburg AU Zentralklnkum, Augsburg H. Wehprecht BB Ruhr Unverstät, Bochum R. Vebahn BC Charté-Campus Vrchow Klnkum der Humboldt Unverstät, Berln U. Fre BE Unverstätsklnkum Benjamn Frankln, Berln G. Offermann BM Klnken der Freen Hansestadt, Bremen K. Drekorn BO Klnkum der Urologschen und Medznschen Unverstät, Bonn H-U. Klehr DR Technschen Unverstät, Dresden J. Passauer DU Med. Enrchtungen der Henrch-Hene-Unverstät, Düsseldorf K. Irens ES Unverstätsklnkum, Essen M. Malagó FM Klnkum der Johann-Wolfgang-Goethe-Unverstät, Frankfurt E. Scheuermann FR Klnkum der Albert-Ludwgs-Unverstät, Freburg G. Krste FD Klnkum Fulda, Fulda R. Werner GI Klnkum der Justus-Lebg-Unverstät, Geßen GO Klnkum der Georg-August-Unverstät, Göttngen F. Schulze HA Klnkum der Martn-Luther-Unverstät, Halle A. Hamza HG Unverstäts-Krankenhaus Eppendorf, Hamburg S. Conrad HM Nephrologsches Zentrum Nedersachsen, Hann. Münden V. Klem HO Klnkum der Medznschen Hochschule, Hannover T. Becker HB Klnkum der Ruprecht-Karls-Unverstät, Hedelberg J. Schmdt HS Klnkum der Unverstät des Saarlandes, Homburg/Saar M. Grndt JE Klnkum der Fredrch-Schller-Unverstät, Jena G. Sten KS Westpfalz-Klnkum, Kaserslautern U. Albert KI Klnkum Chrstan-Albrechts-Unverstät, Kel F. Fändrch 6

8 RENAL PROGRAMS DELEGATE KK Klnk und Polklnk für Knderhelkunde der Unverstät Köln-Londenthal, Köln W. Arns KL Klnk der Unverstät Köln-Lndenthal, Köln W. Arns KM Städtsche Krankenanstalten Köln-Merhem, Köln W. Arns LP Klnkum der Unverstät, Lepzg J. Fangmann LU Klnkum der Medznschen Unverstät, Lübeck L. Frcke MZ Klnkum der Johannes-Gutenberg-Unverstät, Manz E. Wandel MA Klnkum der Stadt, Mannhem P. Schnülle MR Klnkum Lahnberge der Phlpps-Unverstät, Marburg H. Ebel MH Klnkum Rechts der Isar der Technschen Unverstät, München U. Heemann ML Klnkum Großhadern der Ludwg-Maxmlans-Unverstät, München H. Arbogast MN Klnkum der Westfälschen Wlhelms-Unverstät, Münster C. Kreglsten NB Med. Enrchtungen der Unverstät Erlangen-Nürnberg, Nürnberg B. Nonnast-Danel RB Klnkum der Unverstät, Regensburg B. Krämer RO Klnkum der Unverstät, Rostock H. Seter ST Katharnenhosptal, Stuttgart C. Olbrcht TU Klnkum der Eberhard-Karls-Unverstät, Tübngen H. Sessler UL Klnkum der Unverstät, Ulm D. Henne-Bruns WZ Klnkum der Julus-Maxmlans-Unverstät, Würzburg K. Lopau Luxembourg LX Centre Hosptaler de Luxembourg P. Duhoux The Netherlands AW Academsch Medsch Centrum, Amsterdam S. Surachno GR Academsch Zekenhus, Gronngen J. Homan van der Hede LB Leds Unverstar Medsch Centrum, Leden J. de Fjter MS Academsch Zekenhus, Maastrcht J. van Hooff NY Unverstar Medsch Centrum St. Radboud, Njmegen A. Hotsma RD Erasmus Medsch Centrum, Rotterdam W. Wemar RS Sopha Knderzekenhus, Rotterdam K. Cransberg UT Unverstar Medsch Centrum, Utrecht R. Hené UW Wlhelmna Knderzekenhus, Utrecht M. Llen Slovena LO Unversty Medcal Center, Ljubljana D. Kovac HEART PROGRAMS DELEGATE Austra GA Chrurgsche Unverstätsklnk, Graz A. Wasler IB Chrurgsche Unverstätsklnk, Innsbruck L. Müller WG Unverstätsklnk für Chrurge, Wen M. Grmm Belgum AS Onze Leve Vrouw Zekenhus, Aalst W. Tack AN Unverstar Zekenhus Antwerpen, Edegem I. Rodrgus BR ULB, Hôptal Erasme, Bruxelles M. Antone LA Clnques Unverstares St. Luc, Bruxelles A. Poncelet GE Unverstar Zekenhus, Gent F. Caes LM Unverstar Zekenhus Gasthusberg, Leuven J. Vanhaecke LG Centre Hosptaler Unverstare, Lège Germany AK Unverstätsklnkum der Rhensch-Westfälschen TH, Aachen S. Brose BA Herz- & Dabeteszentrum Nordrhen-Westfalen, Bad Oeynhausen G. Tenderch BD Deutsches Herzzentrum, Berln N. Franz DR Unverstätsklnkum >Carl Gustav Carus=, Dresden S. Tugtekn ES Unverstätsklnkum, Essen M. Kamler 7

9 HEART PROGRAMS DELEGATE FM Klnkum der Johann-Wolfgang-Goethe-Unverstät, Frankfurt H.-G. Feguth FR Klnkum der Albert-Ludwgs-Unverstät, Freburg J. Martn FD Klnkum Fulda, Thorax-, Herz- und Gefäßchrurge, Fulda L. Köng GI Klnkum der Justus-Lebg-Unverstät, Geßen J. Bauer GO Klnkum der Georg-August-Unverstät, Göttngen M. Voss HA Klnkum der Martn-Luther-Unverstät, Halle I. Fredrch HG Unverstäts-Krankenhaus Eppendorf, Hamburg F. Wagner HO Klnkum der Medznschen Hochschule, Hannover M. Strüber HB Klnkum der Ruprecht-Karls-Unverstät, Hedelberg HS Klnkum der Unverstät des Saarlandes, Homburg-Saar O. Wendler JE Klnkum der Fredrch-Schller-Unverstät, Jena U. Franke KI Klnkum der Chrstan-Albrechts-Unverstät, Kel S. Hrt KL Klnk der Unverstät Köln-Lndenthal, Köln F. Kuhn-Régner LP Klnkum der Unverstät, Lepzg A. Rahmel MZ Klnkum der Johannes-Gutenberg-Unverstät, Manz W. Kasper-Köng MD Deutsches Herzzentrum, München M. Overbeck ML Klnkum Großhadern der Ludwg-Maxmlans-Unverstät, München B. Meser MN Klnkum der Westfälschen Wlhelms-Unverstät, Münster C. Schmd NB Med. Enrchtungen der Unverstät Erlangen-Nürnberg R. Tandler RB Klnkum der Unverstät, Regensburg A. Lebold The Netherlands GR Academsch Zekenhus, Gronngen M. Erasmus RD Erasmus Medsch Centrum, Rotterdam J. Bekkers UT Unverstar Medsch Centrum, Utrecht E. van de Graaf Slovena LO Unversty Medcal Center, Ljubljana R. Blumauer LUNG PROGRAMS DELEGATE Austra GA Chrurgsche Unverstätsklnk, Graz A. Wasler IB Chrurgsche Unverstätsklnk, Innsbruck L. Müller WG Unverstätsklnk für Chrurge, Wen M. Grmm Belgum AN Unverstar Zekenhus Antwerpen, Edegem I. Rodrgus BR ULB, Hôptal Erasme, Bruxelles M. Antone LA Clnques Unverstares St. Luc, Bruxelles A. Poncelet LM Unverstar Zekenhus Gasthusberg, Leuven J. Vanhaecke Germany BD Deutsches Herzzentrum, Berln N. Franz DR Unverstätsklnkum Carl Gustav Carus 41, Dresden S. Tugtekn ES Unverstätsklnkum, Essen M. Kamler FM Klnkum der Johann-Wolfgang-Goethe-Unverstät, Frankfurt H.-G. Feguth FR Klnkum der Albert-Ludwgs-Unverstät, Freburg J. Martn GI Klnkum der Justus-Lebg-Unverstät, Geßen J. Bauer HG Unverstäts-Krankenhaus Eppendorf, Hamburg F. Wagner HO Klnkum der Medznschen Hochschule, Hannover M. Strüber HS Klnkum Unverstät des Saarlandes, Homburg/Saar O. Wendler JE Klnkum der Fredrch-Schller-Unverstät, Jena U. Franke KI Klnkum der Chrstan-Albrechts-Unverstät, Kel S. Hrt LP Klnkum der Unverstät, Lezpg A. Rahmel MZ Klnkum der Johannes-Gutenberg-Unverstät, Manz W. Kasper-Köng ML Klnkum Großhadern der Ludwg-Maxmlans-Unverstät, München B. Meser MN Klnkum der Westfälschen Wlhelms-Unverstät, Münster C. Schmd 8

10 LUNG PROGRAMS DELEGATE The Netherlands GR Academsch Zekenhus, Gronngen M. Erasmus RD Erasmus Medsch Centrum, Rotterdam J. Bekkers UT Unverstar Medsch Centrum, Utrecht E. van de Graaf LIVER PROGRAMS DELEGATE Austra GA Chrurgsche Unverstätsklnk, Graz F. Iberer IB Chrurgsche Unverstätsklnk, Innsbruck A. Köngsraner WG Unverstätsklnk für Chrurge, Wen R. Stennger Belgum AN Unverstar Zekenhus Antwerpen, Edegem D. Ysebaert BR ULB, Hôptal Erasme, Bruxelles V. Doncker GE Unverstar Zekenhus, Gent R. Tros LA Clnques Unverstares St. Luc, Bruxelles J. Lerut LG Centre Hosptaler Unverstare, Lège O. Detry LM Unverstar Zekenhus Gasthusberg, Leuven J. Prenne Germany AK Unverstätsklnkum der Rhensch-Westfälschen TH, Aachen S. Müller BC Charté-Campus Vrchow Klnkum der Humboldt Unverstät, Berln U. Settmacher BO Chrurgsche Unverstätsklnk, Bonn M. Wolff NB Chrurgsche Klnk der Unverstät Erlangen-Nürnberg, Erlangen T. Meyer ES Unverstätsklnkum, Essen M. Malagó FM Klnkum der Johann-Wolfgang-Goethe-Unverstät, Frankfurt W. Bechsten GO Klnkum der Georg-August-Unverstät, Göttngen T. Lorf HG Unverstäts-Krankenhaus Eppendorf, Hamburg X. Rogers HO Klnkum der Medznschen Hochschule, Hannover B. Nashan HB Klnkum der Ruprecht-Karls-Unverstät, Hedelberg W. Uhl HS Klnkum Unverstät des Saarlandes, Homburg/Saar O. Kollmar JE Klnkum der Fredrch-Schller-Unverstät, Jena KI Klnkum der Chrstan-Albrechts-Unverstät, Kel A. Müller KL Klnk der Unverstät Köln-Lndenthal T. Beckurts LP Klnkum der Unverstät, Lepzg J. Hauss MZ Klnkum der Johannes-Gutenberg-Unverstät, Manz MB Klnkum Otto-von-Guercke Unverstät, Magdeburg H. Lppert MH Klnkum Rechts der Isar der Technschen Unverstät, München M. Stangl ML Klnkum Großhadern der Ludwg-Maxmlans-Unverstät, München R. Schauer MN Klnkum der Westfälschen Wlhelms-Unverstät, Münster C. Kreglsten RB Klnkum der Unverstät, Regensburg H. Schltt RO Klnkum der Unverstät, Rostock W. Schareck TU Klnkum der Eberhard-Karls Unverstät, Tübngen H. Sessler WZ Klnkum der Julus-Maxmlans-Unverstät, Würzburg W. Tmmermann The Netherlands GR Academsch Zekenhus, Gronngen M. Slooff LB Leds Unverstar Medsch Centrum, Leden RD Erasmus Medsch Centrum, Rotterdam H. Tlanus Slovena LO Unversty Medcal Centre, Ljubljana D. Stansavlevc 9

11 PANCREAS (*Islet) PROGRAMS DELEGATE Austra GA Chrurgsche Unverstätsklnk, Graz F. Iberer IB* Chrurgsche Unverstätsklnk, Innsbruck W. Steurer WG Unverstätsklnk für Chrurge, Wen Belgum AN Unverstar Zekenhus Antwerpen, Edegem D. Ysebaert BC* Academsch Zekenhus der Vrje Unverstet, Brussel BR ULB, Hôptal Erasme, Bruxelles L. De Pauw GE Unverstar Zekenhus, Gent U. Hesse LA* Clnques Unverstares St. Luc, Bruxelles J.-P. Squfflet LM Unverstar Zekenhus Gasthusberg, Leuven W. Coosemans LG Centre Hosptaler Unverstare, Lège Germany BC Charté-Campus Vrchow Klnkum der Humboldt Unverstät, Berln A. Kahl BB Knappschaftskrankenhaus, Bochum R. Vebahn BO Chrurgsche Unverstätsklnk, Bonn M. Wolff NB Chrurgsche Klnk der Unverstät Erlangen-Nürnberg, Erlangen T. Meyer ES Unverstätsklnkum, Essen A. Paul FM Klnkum der Johann-Wolfgang-Goethe-Unverstät, Frankfurt FR Klnkum der Albert-Ludwgs-Unverstät, Freburg GI* Klnkum der Justus-Lebg-Unverstät, Geßen D. Wnter HG Unverstäts-Krankenhaus Eppendorf, Hamburg X. Rogers HO Klnkum der Medznschen Hochschule, Hannover R. Lück HB Klnkum der Ruprecht-Karls-Unverstät, Hedelberg KI Klnkum der Chrstan-Albrechts-Unverstät, Kel KL Klnk der Unverstät Köln-Lndenthal T. Beckurts KM Städtsche Krankenanstalten Köln-Merhem, Köln T. Beckurts LP Klnkum der Unverstät, Lepzg H. Wtzgmann LU Klnkum der Medznschen Unverstät, Lübeck L. Frcke MZ Klnkum der Johannes-Gutenberg-Unverstät, Manz MR Klnkum Lahnberge der Phlpps-Unverstät, Marburg A. Hellnger MH Klnkum Rechts der Isar der Technschen Unverstät, München M. Stangl ML Klnkum Großhadern der Ludwg-Maxmlans-Unverstät, München H. Arbogast MN Klnkum der Westfälschen Wlhelms-Unverstät, Münster C. Kreglsten RB Klnkum der Unverstät, Regensburg C. Zülke RO Klnkum der Unverstät, Rostock W. Schareck TU Klnkum der Eberhard-Karls-Unverstät, Tübngen H. Sessler UL Klnkum der Unverstät, Ulm WZ Klnkum der Julus-Maxmlans-Unverstät, Würzburg W. Tmmermann The Netherlands GR Academsch Zekenhus, Gronngen R. Ploeg LB Leds Unverstar Medsch Centrum, Leden J. Rngers TISSUE TYPING LABORATORIES DELEGATE Austra GA Unverstätsklnk, Abtelung für Transfusonsmedzn und Immunohämatologe, Graz U. Posch IB Unverstätsklnk, HLA Labor, Innsbruck H. Schennach OL Allgemenes Krankenhaus, Blutzentrale, Lnz C. Gabrel OW Allgemenes Krankenhaus, HLA Labor, Wels R. Lozenbauer WG Insttut für Blutgruppenserologe, Wen W. Mayr Belgum AN Bloedtransfusecentrum Antwerpen, Belgsche Rode Krus, Edegem A. De Smet BJ Academsch Zekenhus der Vrje Unverstet, Bloedtransfusecentrum Jette, Brussel C. Demanet 10

12 TISSUE TYPING LABORATORIES DELEGATE BR Hôptal Erasme, Tssue typng laboratory, Bruxelles M. Andren GE Unverstar Zekenhus, Tssue typng laboratory, Gent B. Vandekerckhove LA Unversté de Louvan, Tssue typng laboratory, Bruxelles D. Latnne LG Laboratore des Groupes Sanguns, Lège C. Boullenne LM Bloedtransfusecentrum, Belgsche Rode Krus, Leuven M.-P. Emonds Germany BC Charté-Campus Vrchow Klnkum der Humboldt Unverstät, Berln C. Schönemann BE Unverstätsklnkum Benjamn Frankln, Labor für Gewebetypserung, Berln I. Blau DU Insttut für Blutgernnung und Transfusonsmedzn, Düsseldorf R. Wassmuth ER Insttut für Klnsche Immunologe, Erlangen B. Sprewald ES Unverstätsklnkum, Insttut für Immunologe, Essen F. Henemann FM Immunohaematologe, Blutspendedenst Hessen, Frankfurt C. Sedl FR Blutspendedenst, Labor für Gewebetypserung, Freburg GI Insttut für Klnsche Immunologe und Transfusonsmedzn, Geßen K. Barth GO Klnkum der Unverstät, HLA Labor, Göttngen H. Neumeyer HA Insttut für Phathologsche Bocheme, Interdszplnäres Typserungslabor, Halle H. Machulla HG Unverstäts-Krankenhaus Eppendorf, HLA Labor, Hamburg T. Bnder HO Klnkum der Medznschen Hochschule, Immunohaematologe/Blutbank, Hannover M. Hallensleben HB Insttut für Immunologe und Serologe, Hedelberg J. Mytlneos KS Insttut für Rechtsmedzn, Transplantatonsmmunologe, Kaserslautern B. Thele KI Klnkum der Chrstan-Albrechts-Unverstät, HLA Labor, Kel S. Jensch KM Insttut für Transfusonsmedzn, Köln-Merhem S. von Schnakenburg LU Insttut für Immunologe und Transfusonsmedzn, Lübeck S. Müller-Stenhardt MZ Klnkum der Johannes-Gutenberg Unverstät, HLA Labor, Manz W. Htzler ML Knderklnk der Ludwg-Maxmlans-Unverstät, HLA Labor, München RO Klnkum der Unverstät, Abtelung für Transfusonsmedzn, HLA Labor, Rostock V. Kefel TU Klnkum der Eberhard-Karls-Unverstät, Abt. für Transfusonswesen und Blutbank, Tübngen D. Wernet UL DRK Blutspendezentrale, Transplantatonsmmunologe, Ulm C. Flach Luxembourg LX Centre Hosptaler, HLA Lab, Luxembourg F. Hentges The Netherlands AW Centraal Laboratorum Bloedtransfusedenst, Nederlandse Rode Krus, Amsterdam N. Lardy GR Laboratorum voor transplantate-mmunologe, Gronngen S. Lems LB Leden Unversty Medcal Centre, Immunohaematologe, Leden G. Schreuder MS Academsch Zekenhus, Laboratorum voor weefseltyperng, Maastrcht P. van den Berg-Loonen NY Academsch Zekenhus St. Radboud, Bloedtransfusedenst, Njmegen W. Allebes UT Academsch Zekenhus, Bloedbank, Utrecht H. Otten Slovena LO Tssue Typng Centre, Blood Transfuson Centre, Ljubljana B. Vdan-Jeras ETRL Eurotransplant Reference Laboratory, Leds Unverstar Medsch Centrum, Leden, The Netherlands F. Claas, I. Doxads, G. Schreuder 11

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14 Foreword We herewth present the Annual Report 2003, whch ncludes a large amount of data on watng lsts, organ donatons and transplantatons. Ths Annual Report does not nclude any further explanatory texts on the tables and fgures, but we are offerng an extended verson of the Annual Report, ncludng detaled data per country and per center va the Eurotransplant webste The total number of cadaverc transplants n 2003 rose wth no less than 8,25% (2002: 5162; 2003: 5588). Ths was partcularly caused by the ncrease n organ donatons n Belgum, Germany and the Netherlands. Nevertheless, watng lsts for all organs, except for kdney and pancreas, showed a further rse as a result of whch mortalty on all watng lsts, wth the excepton of pancreas, also further ncreased. The role of Eurotransplant s Advsory Commttees remans crucal n the fulfllment of our msson. The Commttees met 13 tmes n total and submtted 22 recommendatons to the Board. Wthout the wllngness of each ndvdual commttee member the development of polcy n our complex organzaton would not be possble. The Board and Drectors are grateful for the contrbutons of all those who are voluntary collaboratng wth Eurotransplant. In June 2003, the Board lost ts oldest member, Henk Schppers, secretary-treasurer. Henk became the frst Drector of Eurotransplant n 1969 and became member of the Board n 1975, when he became drector of a hosptal n the Hague. The death of Henk was a dramatc loss for the whole Eurotransplant communty. He had dedcated much of hs tme to the success of Eurotransplant and the Board and Drectors reman grateful for all he has done. We acknowledge the specal efforts of Mke Smth, who has provded all the data and the tables for ths Annual Report. We would also lke to take ths opportunty to thank all our colleagues n Eurotransplant for ther support. We sncerely hope that you wll enjoy readng the report and wll contnue to jon Eurotransplant n ts efforts to foster organ donaton and transplantaton. Prof. Dr. Yves Vanrenterghem Dr. Bernard Cohen Dr. Gudo G. Persjn Presdent Drector Medcal Drector Leden, May

15 1. Report of the Board and the central offce of Stchtng Eurotransplant Internatonal Foundaton V.C. Depeveen-Hujsman and G.C. Wesenhaan-Stellngwerff, Eurotransplant Internatonal Foundaton, the Netherlands The Board of Stchtng Eurotransplant Internatonal Foundaton met on January 22, May 26, October 8 and 10, One new Board member A was elected by the Assembly: Dr. J. Mytlneos from Hedelberg n the tssue typng secton whereas Prof. J. van Hooff from Maastrcht was re-elected as a Board member A n the kdney/pancreas secton. Dr. J. de Fjter from Leden was apponted as a Board member B representng the Netherlands. The Board apponted Prof. A. van Montfort from Amstelveen as the new secretary/treasurer (Board member D) n successon to Drs. H. Schppers who unfortunately passed away on June 6, The meetngs of the Board, the Fnancal Commttee as well as the Assembly started wth one mnute slence n memory of and to honor Henk Schppers. Moreover, the Board decded to establsh the Henk Schppers Young Investgators Award. Ths award s meant to enable young nvestgators to present ther results of clncal and/or scentfc nvestgatons at well recognzed and respected (nter)natonal transplantaton congresses or symposa. 1.0 General The status of problems wth the German health nsurance companes and the Prüfungskommsson (PK) of the German Bundesärztekammer was a topc of dscusson. ET was confronted wth the fact that the German health nsurance companes (Krankenkassen [KK]) announced ther ntenton to dscontnue the contract wth ET by the end of Arguments for ths decson were ET s request for an ncrease of the regstraton fee as well as problems regardng supposed ncomplete reportng from ET to the PK. The Board decded to awat an arbtraton procedure by the German Mnstry of Health. The arbtraton procedure resulted n the decson to wthdraw the announcement to dscontnue the contract wth ET. The exstng agreements were n fact extended whch led to a contnued frutful cooperaton wth the German partners. The report from an external advsor who performed an n-depth analyss on ET s IT stuaton and the role of follow-up n ET, resulted n Board decsons for mprovement. Suggestons were made for better communcaton wth the users and ncreased partcpaton of the ET Drectors and IT representatves n meetngs of the organ specfc Advsory Commttees as well as the IT manager s partcpaton n Board meetngs. These proposals have been carred out n the meantme. ET was furthermore partcpatng n a small workng group to nvestgate the possblty to mprove collecton of follow-up data. The Board addressed the ssue of fnancal support by pharmaceutcal companes as well as the establshment of a self fundng audt system n conjuncton wth the collecton of follow-up data. Both ssues need further nvestgaton whch wll be carred out by a workng group whch has n the meantme been establshed. The CSWG dscussed plans to renew the ENIS computer system (ENIS). To ths end the IT department performed a study, confrmed by a second opnon, how the future archtecture should look lke. Implementaton of a new Web based ENIS archtecture s expected n ENIS envsons a redesgn of the ENIS watng lst module. In order to avod that the expected realzaton of ENIS n 2005 s delayed, the Board requested from the Advsory Commttees to maxmally restran new adjustments of the allocaton algorthms for the duraton of the ENIS project. 14

16 Several aspects wth regard to non-resdent patents were dscussed: 1. Requests for regstraton of non-resdent patents for HU (re)transplantaton: a polcy how to deal wth such requests wll be establshed. 2. Eurotransplant wrote a letter to all transplant physcans pontng out that t s ther responsblty to check the resdency of a patent. 3. As t appeared to be mpossble to get proper nformaton regardng the defnton of non-resdents from mnstres wthn the ET area, the Board decded to mantan the current defnton for the tme beng: a patent must have hs/her domcle for at least 6 months n the country where he/she wants to enter the ET watng lst. The Board decded not to change the non-resdent polcy for the tme beng and to awat further dscusson and recommendatons from the Ethcs Commttee. The Board dscussed possbltes to alternate the set-up and locaton of the annual ET meetngs. Before takng a decson, an nventory among the ET communty wll be carred out. Broadenng the ET actvtes on a European level was another topc of dscusson. As there already exsts a platform of European organ exchange organzatons where these developments are dscussed, t was decded to keep the ET communty nformed at regular ntervals. As the attendance rate for the votng procedure for Board members A at the annual Assembly s rather low, the Board decded to change the votng procedure. Next year the votng procedure wll be done at the end of the users meetng nvolved at the annual ET meetng. For ths reason, t was also decded to combne the Presdental Symposum and the Assembly n the future. 1.1 Polcy The man part of the Board dscussons concentrated on the proposed recommendatons by the varous Advsory Commttees. Obvously, the work done n these commttees contrbutes to mprove the core of the busness. The Board s grateful for all the tme and efforts the Commttee members have provded to ths mportant part of the work of Eurotransplant. A complete lst of all recommendatons approved n 2003 s publshed under secton 1.4 of ths chapter. The followng man topcs were dscussed and approved: Eurotransplant Kdney Advsory Commttee (ETKAC) The ETKAC accepted the ncluson of mmunzed as well as non-mmunzed patents 65 years, awatng a frst or a retransplant n the ESP program (RKAC01.03). The collecton of ESP follow-up data remaned a matter of concern n The usage of EDTA renal dsease codes n ET was decded upon. However, usage of ICD-10 codes translated nto EDTA codes must also be possble (RKAC03.03). The problem of long watng Belgan/Italan non-resdent patents was dscussed agan. Although the problem s stll not solved, t dmnshed n the meantme. Ths s due to the fact that a consderable number of patents appeared to be double lsted or transplanted n Italy. Due to ncreasng watng tmes for HU kdney patents snce the ntroducton of the 300 extra ponts rule, t was recommended to assgn these patents 500 ponts. The effect should be evaluated after 6 and 12 months (RKAC04.03). Ths recommendaton was mplemented n September 2003 and resulted n a consderable ncrease n HU renal transplantaton. The ETKAC decded that patents prevously transplanted wth non-renal organs and becomng renal nsuffcent after some tme, do not have prorty over other kdney patents on the watng lst (RKAC05.03). 15

17 Eurotransplant Lver Advsory Commttee (ELAC) The 50/50 rule on splt lver allocaton whch was accepted n 2002, resulted n a consderable ncrease n splt lver transplantaton n Gradual mplementaton of the MELD score was one of the most mportant topcs of dscusson n the ELAC and resulted n acceptance of RLAC Another mportant topc of dscusson was prortzaton of T2 over T3 and T4 patents. The ELAC formulated RLAC02.03 whch was mplemented n the meantme. Furthermore, a decson was taken wth regard to ntestne allocaton rules (RLAC03.03). Eurotransplant Pancreas Advsory Commttee (PAC) The PAC dscussed a new pancreas allocaton system, whch was mplemented n the meantme (RPAC01.03 and RPAC02.03). There was dscusson agan on the poor return rate of qualty forms. The soluton of ths problem s stll beng worked on. There was also dscusson on long watng slet patents. The PAC decded that, only after a thorough analyss of ths problem, new rules should be establshed on extreme long watng tmes. Eurotransplant Thoracc Advsory Commttee (ThAC) An echocardographc examnaton and avalablty of an angogram of thoracc donors was consdered to be mplemented as ths procedure s common practce (RThAC01.03). The ThAC decded that re-evaluatons of HU requests wll be taken care of by the ET medcal staff (RThAC03.03). In vew of the ncreased regstraton of HU heart and lung patents from Germany, much more strct acceptance crtera were strongly recommended. It was furthermore encouraged to consder n Germany to adapt the crtera accordng to the crtera of non-german countres (RThAC04.03). The ThAC was nformed on an ENIS watng lst database (MrQ) whch enables montorng of all regstered patents and of HU requests. It s also a framework for follow-up data collecton and t wll enable centers to report and analyze ther own data. The dscusson on the establshment of heart+lung lstng crtera was closed as heart+lung blocks are always kept natonally for whch reason t was felt that allocaton rules should not be made more dffcult. The ThAC formulated rules for splt lung transplantaton n analogy to splt lver rules (RThAC05.03). Eurotransplant Organ Procurement Commttee (OPC) The OPC dscussed ntestne donor crtera and the proposal for pretreatment of ntestne donors as defned by the workng group for ntestne procurement (ROPC01.03). A Belgan request to support backscreenng was dscussed and accepted by the OPC (ROPC03.03). ET s competence n acceptng / declnng compromsed donor organs was dscussed n the OPC and resulted n a recommendaton to the Board that n case of a clear-cut contra-ndcaton for allocaton, the ET medcal staff can refuse to allocate such organs. It should be permtted to transplant these organs locally, whch s the centers own responsblty. The decson to desgnate whether a contra-ndcaton s clear-cut or not, should be taken by the ET medcal staff. Ths recommendaton was not accepted by the Board as the Board felt that t s dffcult to defne what a clear-cut defnton s. Another reason for not acceptng ths recommendaton was the fact that stuatons and opnons regardng (un)acceptable donors/organs are contnuously changng. 16

18 Eurotransplant Computer Servces Workng Group (CSWG) The CSWG was nformed on IT projects that were completed, under constructon or to be started n For other IT actvtes see chapter 1.0 general. Eurotransplant Tssue Typng Advsory Commttee (TTAC) The TTAC met one tme n 2003, but no recommendatons to the Board were formulated. For further nformaton, please read chapter 7 on Hstocompatblty Testng. Eurotransplant Ethcs Commttee (EC) On request of the Board, the EC dscussed a proposal how to deal wth non-resdent patents. In the context of soldarty, utlty and the Hppocratc oath ths ssue was extensvely addressed n the EC. It was concluded that these three ssues cannot be combned and that t s therefore very dffcult to answer the queston rased by the Board. The Ethcs Commttee (EC) dscussed lvng organ donaton n relaton to pad donaton and commercalzaton. There was a tendency wthn the EC aganst monetary compensaton, although some EC members feel that the door should not totally be closed. 17

19 Jont declaraton regardng cooperaton wthn the framework of Eurotransplant Internatonal Foundaton The Mnster of Consumer Affars, Publc Health and Envronment of the Kngdom of Belgum, The Federal Mnster of Health of the Federal Republc of Germany, The Mnster of Health of the Grand Duchy Luxembourg, The Mnster of Health, Welfare and Sport of the Kngdom of the Netherlands, The Federal Mnster of Labour, Health and Socal Affars of the Republc of Austra and The Mnster of Health of the Republc of Slovena ssue the followng jont declaraton regardng cooperaton wthn the framework of Eurotransplant Internatonal Foundaton 1. Introducton As mnsters of health we express our apprecaton of the actvtes of Eurotransplant Internatonal Foundaton (ETI) n Leden, the Netherlands. ETI s a foundaton that has arsen from prvate ntatve. We take the vew: that the mportance of nternatonal cooperaton on organ transplantaton wthn the ETI framework has been demonstrated and should be contnued; that dstrbuton of the allocated donor organs as farly as possble wthn a transparent and objectve allocaton system accordng to medcal crtera s crucal for the acceptance of transplantaton medcne n the partcpatng countres; that a less voluntary form of cooperaton on organ exchange wthn the ETI framework s necessary to retan publc confdence and to brng about the requred strengthenng n ETI=s poston; that government responsblty wthn the exstng regulatory framework for ths area s unequvocal, as wtnessed also by the legslaton passed n the varous countres recently; that the tme s rpe to shape government nvolvement, also gven the background of a possble broadenng n cooperaton wthn the ETI framework; that there s a need for ETI to be strengthened and for a clear and unambguous framework for ETI to operate wthn, as ths wll enable t to perform ts dutes responsbly. 2. Framework Gven the above, we have agreed on the followng framework. It ncorporates the crtera that are essental for ETI to contnue to operate responsbly and has the followng components: - objectve allocaton system accordng to medcal crtera; - safety and qualty requrements; - transparency and follow-up; - government nvolvement. 3. Framework detals An objectve allocaton system accordng to medcal crtera All postmortal organs that become avalable for mplantaton (donor organs) n the partcpatng countres are - takng account of the respectve domestc legslaton - reported to ETI 1. Usng the allocaton crtera arrved at on the bass of consensus, ETI s task s to ensure optmum allocaton of the donor organs. The donor organs are allocated accordng to the followng crtera: the most mportant factor s to maxmze equalty of opportunty for patents, and to do so by takng nto account objectve medcal crtera (e.g. compatblty of organ wth recpent, the expected transplantaton result, medcal urgency and how long a recpent has been watng) as well as ndvdual dfferences; the allocaton system must be patent orented; the allocaton procedures must be transparent and objectve; Procedures must ensure justfed, genune dstrbuton across the partcpatng countres n a manner that takes account of the soldarty prncple wthn each country. 1 Wthn the framework of the twnnng agreements between the partcpatng countres transplantaton centers and smlar nsttutons n other countres the same prncples are appled as those ncluded n the present document. 18

20 The objectve s transparency of the medcal crtera appled to transplantaton and the moment of regstraton on the watng lst. The placng of patents on the watng lst and the determnaton of the crtera appled here are matters prmarly for the doctors concerned and must take place n accordance wth the most recent advances n medcal scence. Safety and qualty requrements The state of a donor organ elgble for allocaton by ETI must comply wth those safety and qualty requrements that can be mposed n accordance wth the most recent advances n medcal scence. ETI must ensure that they do so comply. Transparency and follow-up Gven the need for the allocaton procedures to be transparent and objectve, government n the partcpatng countres must receve current and relable nformaton perodcally - and, f necessary, on request - n order to facltate montorng of the entre organ allocaton process and ensure that the allocaton crtera and the safety and qualty requrements are beng appled. Government nvolvement Ths nvolvement wll be consttuted by ETI s answerablty to government n the partcpatng countres under condtons stll to be elaborated; these wll nclude a perodc evaluaton of how ETI s workng. 4. Acton tems Gven the above consderatons and the need to take account of natonal regulatory frameworks, as well as the efforts drected at the mplementaton of approprate measures to mprove the exstng opportuntes for postmortal organ donaton, we as mnsters of health: promote the reportng wthn the respectve domestc regulatory frameworks of all donor organs to ETI as the organzaton responsble - on the bass of the allocaton crtera arrved at by consensus - for ensurng optmum allocaton of donor organs; request ETI - assumng a patent orented allocaton system wthn the respectve domestc regulatory frameworks, n cooperaton wth experts and n lne wth the most recent advances n medcal scence - to present to government n the partcpatng countres a set of basc prncples for organ allocaton nternatonally; agree wth ETI on what nformaton, n what form, and how, government n the partcpatng countres s to be suppled wth; enter dscusson wth ETI on how to shape government nvolvement; promote dscusson wth and between the expert and professonal organzatons (n the frst nstance medcal professonal organzatons) n the partcpatng countres n order to acheve further clarty for patents elgble for transplantaton; request that ETI, operatng accordng to the general prncples and crtera specfed n ths document, cooperates wth experts from the partcpatng countres and, n close consultaton wth them, generates drectves for the twnnng agreements between the transplantaton centers n the partcpatng countres and smlar nsttutons n other countres. Ths declaraton was sgned n November 2000 by: Brussels, The Mnster of Consumer Affars, Publc Health and Envronment of the Kngdom of Belgum, Magda Aelvoet Bonn, The Federal Mnster of Health of the Federal Republc of Germany, Andrea Fscher Luxembourg, The Mnster of Health of the Grand Duchy of Luxembourg, Georges Wohlfahrt The Hague, The Mnster of Health, Welfare and Sport of the Kngdom of the Netherlands, Els Borst-Elers Venna, The Federal Mnster of Labour, Health and Socal Affars of the Republc of Austra, Lore Hostasch Ljubljana, The Mnster of Health of the Republc of Slovena, Andrej Brucan 19

21 1.2 Central offce General In 2003, a start has been made wth the ENIS- project. Ths project nvolves a revson of the watng lst and transplant regstraton module of ENIS. Besdes the allocaton / regstraton department as well as the nformaton department a lot of transplant centers are nvolved n ths major project. The ENIS- project wll be fnshed n 2005, resultng n a modern ENIS, wth up-to-date technology used. A start has been made wth electronc donor nformaton supply. The Deutsche Stftung Organtransplantaton (DSO) n Germany n close collaboraton wth the Eurotransplant offce s settng up a modern transmsson system to send donor data to Eurotransplant n an electronc way. The mplementaton of ths project s expected n At the end of 2002 the Eurotransplant offce was audted agan for the mantenance of the ISO 9001:2000 certfcate. Ths audt ended wth the postve fndng that Eurotransplant s stll complant wth the ISO standards. Qualty management system The Eurotransplant qualty management system descrbes all processes wthn the Eurotransplant offce. These processes are subdvded nto dfferent categores. In bref these are: Customer-related processes Watng lst management Donor regstraton Allocaton procedures Informaton supply Relaton (clent) management Remote users support Prognostc processes Recpent Follow up Educaton of personnel Selecton of supplers Purchase of resources General processes Legal requrements Strategy and polcy Innovaton Internal audtng Qualty management Durng 2003 Eurotransplant was audted by the Dutch health nspecton and by the German Prüfungskommsson of the Bundesärztekammer. Both authortes had some suggestons for mprovement but were overall satsfed wth the Eurotransplant qualty of work. Most questons regarded possble devatons of the allocaton rules. Agreements have been made as to under what crcumstances devant allocatons are allowed and how these must be documented. Specal nterest was shown n the documentaton of so-called dscarded organs. Eurotransplant therefore set up a documentaton system to keep track of these organs that are dscarded for transplantaton. In 2003, 27 nternal audts were performed. Ths resulted n 15 ntatves for smaller changes and / or mprovements and some ntatves for larger projects. These projects are stll ongong. The regstraton of non conformtes (as ntroduced n 2001) was contnued n Non conformtes nclude mstakes made by our own coworkers and volatons of the Eurotransplant allocaton rules by the transplant centers. Also, problems durng the allocaton process wth tssue typng, donor management and procurement and transportaton are regstered n the system. In 2003, a total of 256 non conformtes were regstered. These non conformtes can be subdvded nto the followng categores: - 95 were mstakes performed by our own coworkers (mostly problems wth regstraton of certan lab values etc nto the ENIS system) were non conformtes of transplant centers. These non conformtes vary from volaton of the allocaton rules n some cases to cases of very late reacton on an organ offer (more than 3 hours) were non conformtes of donor centers. These nclude a too short allocaton tme (less than 6 hours) and errors n suppled donor nformaton. - 8 non conformtes were performed by tssue typng labs. In some cases problems wth the length of tme of cross match results reportng was regstered. The centers n queston were contacted f the problems dd occur regularly. The rest of the non conformtes (5 cases) ncluded transportaton problems (wth arlnes and taxs). Twenty-sx 20

22 of the non conformty cases were consdered to be serous. Therefore, a letter has been wrtten to the center nvolved. A more detaled analyss of these data s performed twce a year. Overall when lookng at the year 2003, the qualty system operated well. As compared to 2002, the number of reported non conformtes has dropped from 517 n 2002 to 256 n Reasons for ths drop are beng nvestgated. A partal answer can be that less volatons are beng performed, snce the strct control especally n Germany, resulted n a structural mprovement. 1.3 Advsory Commttees In 2003, the varous Advsory Commttees met 13 tmes and submtted 22 recommendatons of whch 18 were approved, 2 were rejected and 2 were wthdrawn by the Board. The composton of the varous Advsory Commttees as per December 31, 2003 was as follows: KIDNEY ADVISORY COMMITTEE (ETKAC) Name As of Remarks Prof.Dr. U. Fre, Berln charman, representatve Board Prof.Dr. G. Mayer, Innsbruck representatve Austra Prof.Dr. F. Mühlbacher, Venna representatve Austra Dr. P. Duhoux, Luxembourg representatve Luxembourg Dr. D. Abramowcz, Brussels (BR) representatve Belgum Prof.Dr. J-P. Squfflet, Brussels (LA) representatve Belgum Prof.Dr. G. Offermann, Berln representatve Germany Prof.Dr. K. Drekorn, Bremen representatve Germany Prof.Dr. U. Heemann, Munch representatve Germany Prof.Dr. U. Kunzendorf, Kel representatve Germany Dr. R. Hené, Utrecht representatve the Netherlands Dr. J. de Fjter, Leden representatve the Netherlands Dr. D. Kovac, Ljubljana representatve Slovena Prof.Dr. F.H.J. Claas, Leden (ETRL) representatve TT Assembly Dr. G.G. Persjn, Eurotransplant secretary LIVER ADVISORY COMMITTEE (ELAC) Name As of Remarks Prof.Dr. J. Hauss, Lepzg charman, representatve Board Prof.Dr. A. Köngsraner, Innsbruck representatve Austra Dr. O. Detry, Lège representatve Belgum Prof.Dr. J. Lerut, Brussels (LA) representatve Belgum Prof.Dr. P. Neuhaus, Berln representatve Germany Prof.Dr. K-W. Jauch, Munch representatve Germany Prof.Dr. X. Rogers, Hamburg representatve Germany Dr. B. van Hoek, Leden representatve the Netherlands Dr. D. Stansavljevc, Ljubljana representatve Slovena Dr. T. Gerlng, Eurotransplant secretary PANCREAS ADVISORY COMMITTEE (PAC) Name As of Remarks Prof.Dr. J.P. van Hooff, Maastrcht charman, representatve Board Prof.Dr. A. Köngsraner, Innsbruck representatve Austra Prof.Dr. J-P. Squfflet, Brussels (LA) representatve Belgum Prof.Dr. W. Bechsten, Bochum representatve Germany Prof.Dr. R.G. Bretzel, Gessen representatve Germany Prof.Dr. W. Schareck, Rostock representatve Germany Dr. J. Rngers, Leden representatve the Netherlands Prof.Dr. R.J. Ploeg, Gronngen representatve the Netherlands Prof.Dr. F.H.J. Claas, Leden (ETRL) representatve TT Assembly Dr. K. Djkstra, Eurotransplant secretary 21

23 THORACIC ADVISORY COMMITTEE (ThAC) Name As of Remarks Prof.Dr. G. Laufer, Innsbruck charman, representatve Board Prof.Dr. A. Wasler, Graz representatve Austra Prof.Dr. W. Klepetko, Venna representatve Austra Dr. M. Antone, Brussels (BR) representatve Belgum Prof.Dr. D. Van Raemdonck, Leuven representatve Belgum Dr. B. Meser, Munch representatve Germany Prof.Dr. W. Mohr, Lepzg representatve Germany Prof.Dr. H-G. Feguth, Frankfurt representatve Germany Prof.Dr. R. Hetzer, Berln representatve Germany Dr. A. Balk, Rotterdam representatve the Netherlands Dr. W. van der Bj, Gronngen representatve the Netherlands Dr. R. Blumauer, Ljubljana representatve Slovena Dr. J. Smts, Eurotransplant (nterm) secretary Dr. G. Persjn, Eurotransplant (nterm) secretary ORGAN PROCUREMENT COMMITTEE (OPC) Name As of Remarks Prof.Dr. W.O. Bechsten, Frankfurt charman, representatve Board Dr. P. Wamser, Venna representatve TC s Austra Mr. L. Colenbe, Gent representatve TC s Belgum Mr. D. Horch, Berln representatve TC s Germany Dr. D. Bösebeck, Munch representatve TC s Germany Mr. W. Hordjk, Njmegen representatve TC s NL Dr. T. Pntar, Ljubljana representatve Slovena Prof.Dr. J-P. Squfflet, Brussels (LA) representatve ETKAC Dr. O. Detry, Lège representatve ELAC Dr. J. Rngers, Leden representatve PAC Dr. M. Antone, Brussels (BR) representatve ThAC Dr. I. Doxads, Leden (ETRL) representatve TTAC Dr. J. de Boer, Eurotransplant secretary COMPUTER SERVICES WORKING GROUP (CSWG) Name As of Remarks Prof.Dr. F. Mühlbacher, Venna charman, representatve Board + ETKAC Dr. R. Kramar, Wels representatve Austra Mr. F. Van Gelder, Leuven representatve Belgum Dr. F. Zantvoort, Bremen representatve Germany Dr. A. Hotsma, Njmegen representatve the Netherlands Dr. B. van Hoek representatve ELAC Dr. W. van der Bj, Gronngen representatve ThAC Dr. S. Lems, Gronngen representatve TTAC Mr. W. van Zwet, Eurotransplant secretary TISSUE TYPING ADVISORY COMMITTEE (TTAC) Name As of Remarks Prof.Dr. F.H.J. Claas, Leden (ETRL) charman, representatve Board Prof.Dr. W. Mayr, Venna representatve Austra Prof.Dr. D. Latnne, Brussels (LA) representatve Belgum Dr. F. Hentges, Luxembourg representatve Luxembourg Prof.Dr. R. Wassmuth, Düsseldorf representatve Germany Dr. C. Schönemann, Berln representatve Germany Dr. S. Lems, Gronngen representatve the Netherlands Dr. B. Vdan Jeras, Ljubljana representatve Slovena Prof.Dr. I.I.N. Doxads, Leden (ETRL) secretary ETHICS COMMITTEE (EC) Name As of Remarks Prof.Dr. P. Schotsmans, Leuven charman, representatve Board Drs. M. Bos, The Hague vce-charman, reperesentatve the Netherlands Prof. Redng, Brussels (LA) representatve Belgum Prof.Dr. G. Gubernats, Hanover representatve Germany 22

24 Dr. W. Schaupp, Venna representatve Austra Dr. D. Rgler Pletersk, Ljubljana representatve Slovena Dr. G.C. Wesenhaan-Stellngwerff, ET secretary FINANCIAL COMMITTEE (FC) Name As of Remarks Prof.Dr. A.P.W.P. van Montfort charman, representatve Board Mag. O. Postl, Venna representatve Austra Dr. D. Ysebaert, Antwerp representatve Belgum Prof.Dr. U. Albert, Kaserslautern representatve Germany Dr. B. Cohen, Eurotransplant secretary 1 W. van Zwet, Eurotransplant secretary Recommendatons approved In 2003, the followng recommendatons were submtted by the Advsory Commttees and approved by the Board of Eurotransplant Internatonal Foundaton: Kdney Advsory Commttee RKAC01.03 Immunzed as well as non-mmunzed patents 65 years, awatng a frst or a retransplant, can be ncluded n the ESP program, provded that they have a negatve crossmatch and unacceptable antgens are carefully checked. RKAC03.03 The EDTA renal dsease codes wll be the codes used n ET. However, usage of ICD-10 codes translated nto EDTA codes must also be possble. RKAC04.03 Due to ncreasng watng tmes for HU kdney patents snce the ntroducton of the 300 extra ponts rule, t s recommended to assgn these patents 500 ponts. The effect should be evaluated after 6 and 12 months. RKAC05.03 Patents prevously transplanted wth non-renal organs and becomng renal nsuffcent after some tme, do not have prorty over other kdney patents on the watng lst. Lver Advsory Commttee RLAC01.03 The ELAC s n favour of replacng the current lver allocaton system by adaptng the MELD/PELD score for the stratfcaton of patents on the watng lst. The new allocaton should replace the current system as soon as possble. A feasblty study should be started by mplementng a watng lst module n ENIS (MrQ) for the collecton of ET data for analyss and comparson wth UNOS data. RLAC Patents n T2 are prortzed over T3 and T4 patents at all tmes. 2. Whle n status T2, patents are stratfed by ther watng tme n T2 (date put on T2). 3. The blood group rule s changed and wll allow allocaton of AB0-0 donor lvers to AB0-0 and AB0-B patents (= ET compatblty). 4. The CTP score s ncreased from 10 ponts to 11 ponts. 5. Patents wll not have to be hosptalzed. 6. Calculaton of the CTP score accordng to a revsed defnton. 23

25 RLAC03.03 Intestne allocaton rules are defned as follows: Urgency codes CO (= approved Combned Organ): allocaton accordng to the other organ, except n ntestne and kdney cases; T Transplantable; NT Temporarly not transplantable. Blood group rules AB0-compatble wth AB0-0 to AB0-0, -A, -B and -AB. Allocaton algorthm CO hghest prorty, nternatonally then T natonal, stratfed by total watng tme (ncl. 30 NT days) then T nternatonal, stratfed by total watng tme (ncl. 30 NT days). Pancreas Advsory Commttee RPAC01.03 Allocaton for Combned Organ, Specal Urgency and mmunzed pancreas recpents, allocaton should be accordng to the followng blood group rules: AB0-0 to AB0-0, -A, -B and AB; AB0-B to AB0-B and -AB; AB0-A to AB0-A and -AB and AB0-AB to AB0- AB. Allocaton for electve pancreas patents should be accordng to the followng blood group rules: AB0-0 to AB0-0, AB0-A to AB0-A and -AB, AB0-B to AB0-B and -AB, AB0-AB to AB0-AB. RPAC02.03 Abolsh RPAC nd rephrase and accept the followng allocaton order for electve pancreas+kdney and pancreas-only patents. Pancreas+kdney and pancreas-only organ transplantaton always receve prorty over slet transplantaton. 1. Combned organ [CO] (= mandatory exchange) patents: pancreas+lver or pancreas plus an other organ; (pancreas+kdney patents do not qualfy for the urgency of combned organ transplantaton): - sorted accordng to watng tme on CO; - AB0-blood group compatble. 2. SU-pancreas patents: - sorted accordng to watng tme on SU; - AB0-blood group compatble. 3. Natonal allocaton for ET electve patents: - pont score system: 40% for cold schema perod, 0% for logstc factor and 60% for watng tme; - TPG AB0 blood group dentty.e. compatblty (AB0-0 to AB0-0, AB0-A to AB0-A and -AB, AB0-B to AB0-B and -AB, AB0-AB to AB0-AB). Thoracc Advsory Commttee RThAC01.03 Of all potental thoracc donors, avalablty of an echocardographc examnaton should be amed at. Moreover, of all thoracc donors >40 years, avalablty of a coronary angogram should be amed at. The results should be reported on a standardzed form. RThAC03.03 In order to reduce the workload for audtors and the ET duty desk, re-evaluatons of HU thoracc patents wll be performed by the ET medcal staff. In case of doubt, the audt commttee wll always be contacted. The decson to dscontnue the HU status of a gven patent can only be taken by the audt commttee. RThAC04.03 In vew of the ncreased regstraton of HU heart and lung patents from Germany, much more strct acceptance crtera are strongly recommended. It s furthermore encouraged to consder n Germany to adapt the crtera accordng to the crtera of non-german countres. 24

26 RThAC05.03 In case a center decdes to splt the lung allograft(s) and to perform a lobe transplant n the patent ntally selected by EThAS, the center s allowed to chose a sutable recpent for the other lobe(s) from ts local watng lst. In case no sutable recpent s avalable, frst regonal, then natonal, then nternatonal recpents are selected by Eurotransplant. Ths splt lung allocaton algorthm wll be consdered as an expermental protocol for the duraton of 12 months. Submsson of follow-up data s mandatory. Organ Procurement Commttee ROPC01.03 The OPC - supported by PAC and ELAC - recommends to accept the donor crtera and the proposal for pretreatment of ntestne donors as defned by the workng group for ntestne procurement. The proposal of the workng group on allocaton of ntestnes, should be judged by the ELAC whereas crossmatch requrements should be judged by the TTAC. ROPC03.03 Donor as well as recpent physcans have the moral oblgaton to report any event that may be of mportance for the clncal condton of other recpents of organs and/or tssues of the same donor. Computer Servces Workng Group RCSWG01.03 The CSWG recommends to nvestgate the possbltes of a contnuous self-funded audt system for follow-up data, whch obtans maxmum beneft wth least effort. RCSWG02.03 The Advsory Commttees are asked to maxmally restran new requests for further adjustment of the allocaton algorthms for the duraton of the ENIS project. Fnancal Commttee RFC01.03 The FC recommends the Board to approve the ET Annual Accounts

27 2. Eurotransplant: donaton, watng lst and transplants n 2003 Table 2.1 Number of cadaverc organ donors, from the Eurotransplant regon and used for a transplant, from 1999 to 2003 country populaton pmp 2002/2003 (mllon) Austra % Belgum % Germany % Luxembourg % Netherlands % Slovena % total % ETable 2.2 Number of cadaverc organ donors, from the Eurotransplant regon and used for a transplant, by organ from 1999 to 2003 year of regstraton /2003 organ donors, total % organ donors, by organ Sum: kdney % heart % lung % lver % pancreas % Number of cadaverc organ donors, from the Eurotransplant regon and used for a transplant, by organ and country from 1999 to 2003 kdney /2003 Austra % Belgum % Germany % Luxembourg % Netherlands % Slovena % total % heart /2003 Austra % Belgum % Germany % Luxembourg % Netherlands % Slovena % total % lver /2003 Austra % Belgum % Germany % Luxembourg % Netherlands % Slovena % total % 26

28 Table 2.2 Number of cadaverc organ donors, from the Eurotransplant regon and used for a transplant, by organ from 1999 to 2003 (contnued) year of regstraton /2003 lung /2003 Austra % Belgum % Germany % Luxembourg % Netherlands % Slovena % total % pancreas /2003 Austra % Belgum % Germany % Luxembourg % Netherlands % Slovena % total % Table 2.3 Demographc data on cadaverc organ donors, from the Eurotransplant regon and used for a transplant from 1999 to 2003 age % % 31.4 % % 7.1 % % 4.6 % >= % 16.4 % not reported % total % 8.7 % sex % female % 14.6 % male % 4.3 % total % 8.7 % blood group % A % 10.3 % AB % 0.0 % B % 1.7 % O % 9.9 % total % 8.7 % cause of death % accdent % 3.1 % natural % 10.2 % sucde % -1.5 % other % total % 8.7 % 27

29 Table 2.4a Type of cadaverc organ donaton, used n a transplant, from 1999 to % 2002/2003 kdney donor SOD % 8.4 % MOD % 10.7 % kdney donor total % 10.0 % non-kdney donor SOD % -8.7 % MOD % -4.0 % non-kdney donor total % -7.9 % total % 8.5 % Table 2.4b Type of cadaverc organ donaton, used n a transplant, by country of donor orgn for 2003 kdney donor non-kdney donor SOD MOD % MOD total SOD MOD % MOD total total % Austra % % % Belgum % % % Germany % % % Luxembourg % ,0% % Netherlands % % % Slovena % ,0% % non ET % % % total % % % SOD- sngle organ donor MOD - multple organ donor Table 2.4c Non-heart beatng donors 2003 donor country NHB Category Austra Belgum Netherlands total I - dead on arrval II- unsuccesful resusctaton III - awatng heart arrest IV - heart arrest n bran death donor total Table 2.5 Sze of the actve Eurotransplant watng lst, by organ, as per December 31, from 1999 to 2003 watng lst type composton /2003 heart heart % heart + lver % heart + lver + lung % heart + lung % kdney + heart % total % watng lst type composton /2003 kdney kdney % kdney + heart % kdney + lver % kdney + lver + pancreas % kdney + pancreas % kndey + lung % total % 28

30 Table 2.5 Sze of the actve Eurotransplant watng lst, by organ, as per December 31, from 1999 to 2003 (contnued) watng lst type composton /2003 lver lver % heart + lver % heart + lver + lung % kdney + lver % kdney + lver + pancreas % lver + lung % lver + pancreas % total % watng lst type composton /2003 lung lung % heart + lver + lung % heart + lung % kndey + lung % lver + lung % total % watng lst type composton /2003 pancreas pancreas % kdney + lver + pancreas % kdney + pancreas % lver + pancreas % total % total % Table 2.6 Regstratons on the Eurotransplant watng lst, by organ from 1999 to 2003 All regstraton events /2003 kdney % heart % lung % lver % pancreas % New regstratons /2003 kdney % heart % lung % lver % pancreas % Re - regstratons /2003 kdney % heart % lung % lver % pancreas % 29

31 Table 2.7 Number of transplanted organs wthn Eurotransplant area, by organ, by donor type from cadaver /2003 kdney % heart % lung % lver % pancreas % total % lvng /2003 kdney % heart * % lung % lver * % total % * domno Table 2.8 Transplants n the Eurotransplant regon, from Cadaverc Donors /2003 Heart % Kdney % Sngle lung % Both lungs % Lver % Splt lver % Heart + kdney % Heart + both lungs % Heart + lver Kdney + lung Kdney + both lungs % Kdney + lver % Kdney + splt lver % Lver + both lungs % Splt lver + both lungs % Heart + both lungs + kdney Heart + both lungs + lver Heart + kdney + lver Heart + sngle lung Panceas % Pancreas + kdney % Pancreas + lver % Pancreas + splt lver Pancrea + lver + kdney Pancreas slets % Pancreas slets + lver % Pancreas slets + kdney % Total % Lvng Donors /2003 Heart Kdney % Lver % Lung Splt lver % Total % Type of donor /2003 Cadaverc donors ,25 % Lvng donors ,8 % Total ,3 % Table 2.9 Mortalty on the Eurotransplant Watng Lst, from kdney heart lung lver pancreas total

32 KTable 3.1 Cadaverc donor kdneys n the Eurotransplant regon n Kdney: donaton, watng lsts, and transplants Donors donor country Austra Belgum Germany Luxembourg Netherlands Slovena total cadaverc donors not kdney donors cadaverc kdney donors Kdneys donor country Austra Belgum Germany Luxembourg Netherlands Slovena total potental kdneys kdneys not reported reported kdneys kdneys not procured procured kdneys kdneys not transplanted kdneys transplanted Table 3.2 Actve cadaverc kdney transplant watng lst as per December 31, characterstcs Type of transplant Austra Belgum Germany Luxembourg Netherlands Slovena total % kdney % kdney+heart % kdney+lver % kdney+lver+pancreas % kdney+pancreas % total % Table 3.3 Actve cadaverc kdney only transplant watng lst as per December 31, characterstcs blood group % PRA current sequence tme watng (dalyss) (years) not not pre year A AB B O reported 0-5% 6-84% % reported frst repeat emptve % 38.6% 2.2% 10.8% 48.5% 0.0% 89.4% 9.4% 1.0% 0.2% 84.5% 15.5% 1.9% 24.9% 48.6% 24.6% % 39.3% 2.2% 10.5% 48.0% 0.0% 88.9% 9.7% 0.9% 0.5% 84.5% 15.5% 1.6% 26.2% 48.8% 23.4% % 39.9% 2.3% 10.3% 47.6% 0.0% 89.0% 9.7% 0.8% 0.4% 84.7% 15.3% 1.7% 26.3% 49.2% 22.9% % 39.4% 2.1% 10.3% 48.1% 0.0% 88.5% 10.5% 0.8% 0.2% 84.2% 15.8% 1.2% 27.9% 48.6% 22.3% 31

33 Table 3.4 Kdney transplants characterstcs Cadaverc donor kdney transplants type of transplant Austra Belgum Germany Luxembourg Netherlands Slovena non ET total % kdney only % kdney en bloc % kdney + pancreas % kdney + heart % kdney + splt lver % kdney + whole lver % kdney + heart + both lungs % kndey + pancreas + whole lver % total % Kdney only transplant (ncludng kdney en bloc) HLA - A, B, DR msmatches Austra Belgum Germany Luxembourg Netherlands Slovena non ET total % % % % % % % % not calculated % total % blood group Austra Belgum Germany Luxembourg Netherlands Slovena non ET total % A % AB % B % O % total % PRA Austra Belgum Germany Luxembourg Netherlands Slovena non ET total % 0-5% % 6-84% % % % not reported % total % wat (months) (dalyss) Austra Belgum Germany Luxembourg Netherlands Slovena non ET total % % % % % % pre emptve % total % sequence Austra Belgum Germany Luxembourg Netherlands Slovena non ET total % frst % repeat % total % 32

34 Kdney watng lst Lvng donor transplants Cadaverc donor transplants Fgure 3.1. Dynamcs of the Eurotransplant kdney transplant watng lst and transplants between 1969 and 2003 Table 3.5 Lvng donor kdney transplants - kdney only kdney only Austra Belgum Germany Netherlands total % related % non related % total % Related Austra Belgum Germany Netherlands total % blood related: NOS * % brother / sster % father % grand father / - mother % mother % nephew / nece % son / daughter % uncle / aunt % total % Non related Austra Belgum Germany Netherlands total % other % spouse % total % * Not otherwse specfed 33

35 4. Thoracc organs: donaton, watng lsts, and transplants Table 4.1 Cadaverc donor hearts n the Eurotransplant regon n 2003 Donors donor country Austra Belgum Germany Luxembourg Netherlands Slovena total cadaverc donors not heart donors cadaverc heart donors Hearts donor country Austra Belgum Germany Luxembourg Netherlands Slovena total reported not procured procured not transplanted transplanted Table 4.2 Cadaverc donor lungs n the Eurotransplant regon n 2003 Donors donor country Austra Belgum Germany Luxembourg Netherlands Slovena total cadaverc donors not lung donors cadaverc lung donors Lungs donor country Austra Belgum Germany Luxembourg Netherlands Slovena total potental lungs not reported reported lungs not procured procured not transplanted transplanted Table 4.3 Actve cadaverc heart transplant watng lst as per December 31, characterstcs type of transplant Austra Belgum Germany Netherlands Slovena total % heart % heart+lung % kdney+heart % total % 34

36 Table 4.4 Actve cadaverc heart transplant watng lst as per December 31, characterstcs blood group sequence tme watng (regstraton months) not year A AB B O reported frst repeat % 48.6% 2.2% 10.8% 38.5% 0.0% 96.8% 3.2% 57.4% 25.9% 14.4% 1.4% % 51.4% 3.8% 10.5% 34.2% 0.0% 96.7% 3.3% 61.0% 26.3% 11.5% 1.2% % 51.1% 5.0% 8.4% 35.6% 0.0% 97.4% 2.6% 56.8% 29.4% 10.7% 3.1% % 42.3% 3.1% 11.5% 43.1% 0.0% 98.1% 1.9% 58.4% 22.1% 16.1% 3.5% Table 4.5 Actve heart + lung transplant watng lst as per December 31, characterstcs type of transplant Austra Belgum Germany Netherlands total % heart+lung % total % Table 4.6 Actve cadaverc heart + lung only transplant watng lst as per December 31, characterstcs blood group sequence tme watng (regstraton months) not year A AB B O reported frst repeat % 35.6% 4.4% 6.7% 53.3% 0.0% 100.0% 0.0% 24.4% 31.1% 20.0% 15.6% % 28.6% 7.1% 9.5% 54.8% 0.0% 100.0% 0.0% 19.0% 26.2% 21.4% 33.3% % 41.9% 0.0% 4.7% 53.5% 0.0% 100.0% 0.0% 41.9% 14.0% 14.0% 30.2% % 35.7% 2.4% 4.8% 57.1% 0.0% 100.0% 0.0% 31.0% 19.0% 9.5% 40.5% Actve watng lst Heart transplants Fgure 4.1. Dynamcs of the Eurotransplant heart watng lst and transplants betweeen 1991 and

37 Table 4.7 Actve lung transplant watng lst as per December 31, characterstcs type of transplant Austra Belgum Germany Netherlands total % lung % heart + lung % lver + lung % total % Table 4.8 Actve cadaverc lung only transplant watng lst as per December 31, characterstcs blood group sequence tme watng (regstraton months) not year A AB B O reported frst repeat % 30.8% 2.9% 12.5% 53.8% 0.0% 96.7% 3.3% 38.6% 24.2% 24.2% 11.3% % 32.9% 1.7% 8.5% 56.9% 0.0% 97.8% 2.2% 43.8% 24.8% 20.0% 9.4% % 35.3% 2.1% 9.0% 53.6% 0.0% 97.2% 2.8% 34.6% 26.5% 22.3% 14.5% % 37.3% 4.0% 7.0% 51.7% 0.0% 97.3% 2.7% 38.3% 21.7% 28.7% 9.1% Table 4.9 Heart transplants characterstcs Cadaverc donor heart transplants type of transplant Austra Belgum Germany Netherlands Slovena non ET total % heart only % kdney + heart % heart + both lungs % heart + kdney + both lungs % heart + whole lver + both lungs % heart + whole lver % total % Heart only transplant blood group Austra Belgum Germany Netherlands Slovena non ET total % A % AB % B % O % total % wat (months - regstraton) Austra Belgum Germany Netherlands Slovena non ET total % % % % % % total % sequence Austra Belgum Germany Netherlands Slovena non ET total % frst % repeat % total % 36

38 Table 4.10 Heart + lung transplants characterstcs Cadaverc donor heart + lung transplants type of transplant Austra Belgum Germany Netherlands Slovena non ET total % heart only % kdney + heart % heart + both lungs % heart + kdney + both lungs % heart + whole lver + both lungs % heart + whole lver % total % Heart + lung only transplant blood group Austra Belgum Germany Netherlands total % A % AB % B % O % total % wat (months - regstraton) Austra Belgum Germany Netherlands total % % % % % total % sequence Austra Belgum Germany Netherlands total % frst % total % Lung watng lst Heart+Lung watng lst Heart+Lung transplants Lung transplants Fgure 4.2. Dynamcs of the Eurotransplant heart + lung watng lst and heart + lung transplants and Eurotransplant lung watng lst and lung transplants between 1991 and

39 Table 4.11 Lung transplants characterstcs Cadaverc donor lung transplants type of transplant Austra Belgum Germany Netherlands non ET total % Sngle lung % Both lungs * % Both lungs + whole lver % both lungs + heart % kdney + heart + both lungs % heart + both lungs + whole lver % total % * The frst splt-lung transplantaton n two patents was performed n Hannover Lung only transplant blood group Austra Belgum Germany Netherlands non ET total % A % AB % B % O % total % wat (months - regstraton) Austra Belgum Germany Netherlands non ET total % % % % % % total % sequence Austra Belgum Germany Netherlands non ET total % frst % repeat % total % 38

40 L5. Lver: donaton, watng lsts, and transplants Table 5.1 Cadaverc donor lvers n the Eurotransplant regon n 2003 Donors Donor procedures Whole lvers donor country Austra Belgum Germany Luxembourg Netherlands Slovena total cadaverc donors not lver donors cadaverc lver donors donor country Austra Belgum Germany Luxembourg Netherlands Slovena total whole lver procedure splt lver procedure total donor country Austra Belgum Germany Luxembourg Netherlands Slovena total reported not procured procured not transplanted transplanted Splt lvers donor country Austra Belgum Germany Luxembourg Netherlands Slovena total potental splt lvers splt lver not used splt lver transplanted Table 5.2 Actve cadaverc lver transplant watng lst as per December 31, characterstcs type of transplant Austra Belgum Germany Netherlands Slovena total % lver % lver + kdney % lver + kdney + pancreas % lver + lung % lver + pancreas % total % 39

41 Table 5.3 Actve cadaverc lver only transplant watng lst as per December 31, characterstcs blood group sequence tme watng (regstraton months) not not year A AB B O reported frst repeat reported % 43.9% 3.6% 14.2% 38.4% 0.0% 94.6% 5.4% 44.3% 32.4% 19.0% 4.0% 0.0% % 43.7% 2.9% 15.0% 38.4% 0.0% 94.1% 5.9% 55.3% 28.3% 13.8% 1.9% 0.6% % 44.2% 3.5% 16.4% 35.9% 0.0% 94.6% 5.4% 58.8% 30.8% 9.3% 0.9% 0.2% % 42.1% 3.9% 15.9% 38.0% 0.0% 95.2% 4.8% 71.2% 21.3% 5.6% 1.6% 0.3% Table 5.4 Lver transplants characterstcs Cadaverc donor lver transplants type of transplant Austra Belgum Germany Netherlands Slovena non ET total % splt lver % whole lver % kdney + splt lver % kdney + whole lver % both lungs + whole lver % pancreas + whole lver % heart + both lungs + whole lver % heart + whole lver % kdney + pancreas + whole lver % total % Lver only (cadaverc donor) transplant blood group Austra Belgum Germany Netherlands Slovena non ET total % A % AB % B % O % total % wat (regstraton months) Austra Belgum Germany Netherlands Slovena non ET total % % % % % % total % sequence Austra Belgum Germany Netherlands Slovena non ET total % frst % repeat % total % Table 5.5 Lvng donor lver transplants - lver only 2003 Lver only Austra Belgum Germany Netherlands total % domno % non related % related % total % 40

42 Table 5.5 Lvng donor lver transplants - lver only 2003 (contnued) related Austra Belgum Germany Netherlands total % brother / sster % father % grand father / mother % mother % nephew / nece % son / daughter % uncle / aunt % total % non related Austra Belgum Germany Netherlands total % other % spouse % total % Intestne transplants 2003 On January 1, 2003, 13 patents were on the watng lst for an ntestnal transplant (8 n Germany, 2 n Belgum, 2 n Austra and 1 n the Netherlands). Durng the year 2003, 15 patents were regstered for ether an ntestnal transplant (N=9) or for a combned ntestnal transplant (N=6). As per December 31, 2003, 15 patents were awatng ether an solated ntestnal transplant (N=8) or n combnaton wth another organ (N=7). In 2003, 12 ntestnal transplants were performed (BC:2; IB:3; GR1; KL:1; KI:5). Eght transplants were solated ntestne transplants and 4 were combned ntestne transplants. In 2002, 6 solated ntestne transplants were performed as well as 6 combned ntestne transplants. All of these were obtaned through sharng, thus not from local donors. Three patents ded whle awatng a transplant Lver watng lst Lvng donor transplants* Cadaverc donor transplants Fgure 5.1. Dynamcs of the Eurotransplant lver watng lst and lver transplants between 1991 and 2003 * ncludng domno transplants 41

43 6. Pancreas: donaton, watng lsts, and transplants PTable 6.1 Cadaverc donor pancreas n the Eurotransplant regon n 2003 Donors donor country Austra Belgum Germany Luxembourg Netherlands Slovena total cadaverc donors not pancreas donors cadaverc pancreas donors Pancreas donor country Austra Belgum Germany Luxembourg Netherlands Slovena total reported not procured procured not transplanted transplanted Table 6.2 Actve cadaverc pancreas transplant watng lst as per December 31, characterstcs type of transplant Austra Belgum Germany Netherlands total % kdney+lver+pancreas % kdney+pancreas % lver+pancreas % pancreas % total % Table 6.3a Actve cadaverc pancreas only transplant watng lst as per December 31, characterstcs blood group sequence tme watng (regstraton months) not year A AB B O reported frst repeat % 40.0% 1.3% 5.3% 53.3% 0.0% 65.3% 33.3% 25.3% 24.0% 24.0% 13.3% % 40.6% 1.6% 4.7% 53.1% 0.0% 71.9% 28.1% 50.0% 14.1% 14.1% 21.9% % 37.1% 1.4% 8.6% 52.9% 0.0% 58.6% 41.4% 28.6% 10.0% 21.4% 40.0% % 39.1% 1.1% 10.3% 49.4% 0.0% 55.2% 44.8% 19.5% 14.9% 23.0% 42.5% 42

44 Table 6.3b Actve cadaverc kdney+pancreas transplant watng lst as per December 31, characterstcs blood group sequence tme watng (regstraton months) not year A AB B O reported frst repeat % 31.8% 2.3% 12.5% 53.4% 0.0% 94.3% 5.7% 43.8% 28.4% 25.6% 2.3% % 37.9% 1.4% 7.3% 53.4% 0.0% 95.0% 5.0% 43.8% 39.3% 13.2% 3.7% % 29.9% 4.9% 8.3% 56.9% 0.0% 95.1% 4.9% 53.5% 25.0% 19.4% 2.1% % 33.3% 1.5% 7.7% 57.4% 0.0% 93.8% 6.2% 41.5% 39.0% 17.4% 2.1% Table 6.4a Pancreas transplants characterstcs Cadaverc donor pancreas transplants type of transplant Austra Belgum Germany Netherlands total % Pancreas % Islets % Kdney + pancreas % Kdney + slets % Kdney + lver + pancreas % Pancreas + lver % total % Pancreas only (cadaverc donor) transplant blood group Austra Belgum Germany Netherlands total % A % AB % B % O % total % wat (regstraton months) Austra Belgum Germany Netherlands total % % % % % total % sequence Austra Belgum Germany Netherlands total % frst % repeat % total % Table 6.4b Number of pancreas slet transplantatons 2003 AIBTP BBCTP BLATP GGITP total recpents transplanted number of transplants number of donors used

45 Table 6.4c Pancreas transplants characterstcs Cadaverc donor pancreas transplants type of transplant Austra Belgum Germany Netherlands total % Pancreas % Islets % Kdney + pancreas % Kdney + slets % Kdney + lver + pancreas % Pancreas + lver % total % Pancreas + kdney only (cadaverc donor) transplants blood group Austra Belgum Germany Netherlands total % A % AB % B % O % total % wat (regstraton months) Austra Belgum Germany Netherlands total % % % % % % total % sequence Austra Belgum Germany Netherlands total % frst % repeat % total % Islet+Kdney & Pancreas+Kdney watng lst Pancreas+Kdney transplants * Islets+Kdney transplant Pancreas transplants Islet transplants Fgure 6.1. Dynamcs of the Eurotransplant pancreas + kdney and slet + kdney watng lst, pancreas + kdney, slet + kdney, pancreas and slet-only transplants between 1991 and 2003 * ncludng 1 pancreas+kdney+lver transplant and domno transplant 2 pancreas+lver transplant 44

46 H7. Hstocompatblty Testng 7.1 Introducton I.I.N. Doxads, PhD and F.H.J. Claas, PhD, Eurotransplant Reference Laboratory, Department of Immunohaematology and Blood Transfuson, Leden Unversty Medcal Center, Leden, The Netherlands An ongong task of the Eurotransplant Reference Laboratory (ETRL) s the mprovement and mantenance of the hgh qualty of HLA typng, screenng for transplantaton relevant antbodes and crossmatchng wthn Eurotransplant and ts afflated centers. Ths task s addressed by organsng profcency testng schemes (External Profcency Testng Exercses) for the Tssue Typng Centers (TTC) collaboratng wth Eurotransplant (ET). Furthermore, the ETRL ntates studes and promotes dscussons for possble new recommendatons wth the help of the Tssue Typng Advsory Commttee (TTAC). In addton, n the past 18 years the ETRL has addressed the problem of hghly senstsed patents, by organsng and promotng the Acceptable Msmatch (AM) program. Furthermore, vsts to the afflated TTC belongs to ts dutes (2003: 4). A 24 hours a day, 7 days a week duty for all transplantaton relevant mmunologcal aspects for all patents wthn ET rounds up the tasks of the ETRL. 7.2 Eurotransplant External Profcency Testng (EPT) Schemes The EPT Schemes appled n 2003 to determne the ndvdual performance of the TTC s are reported below External Profcency Testng on HLA typng In 2003, each partcpatng laboratory receved eght blood samples for typng and was asked to report the results before a certan deadlne. For the analyss of the results a 75% consensus rule was used. Ths rule has been ntroduced by the European Federaton for Immunogenetcs (EFI) and facltated the acceptance for possble dscrepances. A consensus was obtaned for all HLA-A, B and DR antgens (specfctes). The results based on the report of the splt HLA specfctes are summarsed n the Table 1 below Table 7.1: External Profcency Testng Exercses on HLA typng (N=57 partcpants; 411 typng reports) Dscrepant (N)* %Dscrepancy HLA-A, B HLA-DR * Includng the use of erroneous nomenclature Snce the TTC use serologcal and molecular methods for HLA typng no dfferentaton wth respect to the method was done. The dscrepances were presumably due to clercal errors and not to msnterpretaton of the results External Profcency Testng Exercses on molecular typng For the EPT on molecular typng two sets of 5 DNA samples each (DNA#22 and DNA#23) were sent to the TTC. The DNA was solated from spleen cells of organ donors, perpheral blood cells from healthy blood donors or cell lnes. Rare alleles or haplotypes were ncluded. The partcpants could report results on MHC class I and class II typng on the two or four dgt resoluton level. In the table 2 the total number of typngs reported s gven and n table 3 the number and type of dscrepant results receved: 45

47 Table 7.2: Report of molecular typng results MHC Locus Typngs (N) 2d* 4d* Class I HLA-A HLA-B Class II HLA-DRB HLA-DQB * = Resoluton level of 2 dgts (2d) e.g. HLA-A*02 or 4 dgts (4d) e.g. HLA-A*0201 Table 7.3: Total number of dscrepant typngs MHC N 2 d 4 d HLA-A HLA-A,B HLA-DRB HLA-DQB N = erroneous use of nomenclature The number of dscrepances for HLA-A, B s sgnfcantly lower than n the past years due to commercal kts of the partcpants. Nomenclature problems are stll present but a better accommodaton presumably due to the Accredtaton and Certfcaton procedure s obvous. In the future only the so-called 2 dgt typng wll be reported to the ETRL External Profcency Testng on Crossmatchng As n the past, TTC partcpatng n ths External Profcency Testng Exercse were asked to perform crossmatches usng the cells provded for the Profcency Testng Exercse on serologcal typng and the sera of four dfferent Eurotransplant patents selected by the ETRL. The TTC used the local crossmatch technques to smulate the day-to-day practce. In total 32 sera had to be crossmatched per TTC. For the centers not recevng the sera of the patents on the watng lst, as Scanda Transplant and German centers performng transplant recpents hstocompatblty work only eght sera were selected and sent to the partcpants. These TTC had to perform 64 crossmatches n total. The method used was CDC wth and wthout addton of dthothretol. The results of ths EPT reman as n the prevous years, showng that only when the complete hstory of the patent s known crossmatch results can be nterpreted External Profcency Testng Exercse on Screenng The scheme of the EPT Exercses on screenng conssts of a send out of 4 serum samples from multparous women 4 tmes per year. The HLA typng of the serum donor, the mmunsng partner and of one of the chldren s known n almost all nstances, but not reported to the partcpants beforehand. The ETRL receved results from 63 partcpants workng n the feld of transplantaton. All but one (flow cytometry) performed CDC as ther routne screenng procedure, wth addton or not of dthothretol. Results of sold phase assays (generc ELISA) are now also reported by almost 50% of the partcpants. Here the dscrepancy rate s very low. The % PRA value as obtaned by CDC remans unrelable. The report of HLA specfc antbodes n ths perod s contnuously evolvng and s sgnfcantly better than n prevous years. 7.3 Programmes for the hghly senstsed patents n Eurotransplant In the perod the Acceptable Msmatch Programme (AM) program organsed and controlled by the ETRL has been an effcent tool to a number of hghly senstzed patents. Ths program s open for all patents 46

48 of Eurotransplant. Informaton for partcpaton can be obtaned from the ETRL or the Eurotransplant Admnstraton. A comparson between the perod and s depscted n fgure 7.1. Whle the number of transplantated AM patents ncreased n Austra, German and the Netherlands, a decrease s observed n Belgum. The AM lst currently ncludes 160 patents from Eurotransplant and afflated countres (fgure 7.2). 7.4 Other actvtes The tenth Extra Mural Meetng The tenth Extra Mural Meetng was held n Berln, Germany, on February 28, 2003, wth presentatons on the role of HLA-DR matchng, problems wth crossmatchng and selecton of patents. The partcpants dscussed the newest aspects of screenng for HLA specfc antbodes. Annual Tssue Typers Meetng The Annual Tssue Typers Meetng was held n October 2003 n Leden. Over a hundred partcpants from the dfferent TTC were present. The major topc was the relevance of matchng n kdney transplantaton. Tssue Typng Advsory Commttee (TTAC) The mnutes of the meetngs of the TTAC have been publshed n the ET Newsletter. It should be noted that the TTAC makes both the agenda and a summary of the mnutes avalable to all TTC. All centers have therefore the opportunty to react on the dfferent dscusson ponts. Throughout 2003 the TTAC dscussed problems related to the stuaton n Germany, where the TTC were dvded nto those performng donor and recpent actvtes and those performng patent specfc tasks only. N N N A B G NL T 0 A B G L NL SLO OTH Fgure 7.1. Transplanted AM patents Fgure 7.2. Patents n the AM watng lst per

49 P8. Publcatons n Publcatons Artcles The names of authors who work at the Eurotransplant central offce or Eurotransplant Reference Laboratory are n Italc. Sjpkens YWJ, Doxads IIN, Mallat MJK, Fjter de JW, Brujn JA, Claas FHJ, Paul LC Early versus late acute rejecton epsodes n renal transplantaton In: Transplantaton Jan 27, 2003; 75(2): Deng MC, Smts JMA, Young JB Proposton: the beneft of cardac transplantaton n stable outpatents wth heart falure should be tested n a randomzed tral In: J Heart Lung Transplant Feb 2003, 22(2): Dankers MKA, Roelen DL, Meer-Prns van der EMW, Lange de P, Korfage N, Smts JMA, Persjn GG, Welsh, KI, Doxads IIN, Claas FHJ Dfferental mmunogencty of HLA msmatches: HLA-A2 versus HLA-A28 In: Transplantaton Feb ; 75 (3): Duquesnoy RJ, Takemoto S, Lange de P, Doxads IIN, Schreuder GMT, Claas FHJ, Persjn GG HLA matchmaker: A molecularly based algorthm for hstocompatblty determnaton III. Effect of matchng at the HLA-A,B amno acd trplet level on kdney transplant survval. In: Transplantaton March ; 75 (6): Smts JMA, De Meester J, Deng MC, Scheld HH, Hummel M, Schoendube F, Haverch A, Vanhaecke J, Houwelngen van HC Mortalty rates after heart transplantaton: How to compare center-specfc outcome data? In: Transplantaton 2003; 75(1): Doxads IIN, Claas FHJ The short story of HLA and ts methods In: Dev Ophthalmol 2003; 36: 5-11 Beekhus WH, Bartels M, Doxads IIN, Rj van G Degree of compatblty for HLA-A and -B affects outcome n hgh-rsk corneal transplantaton In: Dev Ophthalmol 2003; 36: Völker-Deben HJ, Schreuder GMT, Claas FHJ, Doxads IIN, Schpper RF, Pels E, Persjn GG, Smts JMA, D Amaro J Hstocompatblty and corneal transplantaton In: Dev Ophthalmol 2003; 36: Claas FHJ, Roelen DL, Oudshoorn M, Doxads IIN Future HLA matchng strateges n clncal transplantaton In: Dev Ophthalmol 2003; 36: Sjpkens YWJ, Doxads IIN, Kemenade van FJ, Zwnderman AH, Fjter de JW, Claas FHJ, Brujn JA, Paul LC Chronc rejecton wth or wthout transplant vasculopathy In: Clncal Transpl 2003; 17(3):

50 Roodnat JI, Remsdjk van IC, Mulder PGH, Doxads IIN, Claas FHJ, IJzermans JNM, Gelder van T, Wemar W The superor results of lvng donor renal transplantaton are not completely due to selecton or short cold schema tme In: Transplantaton 2003; 75 Dankers MKA, Roelen DL, Korfage N, Lange de P, Wtvlet M, Sandkujl L, Doxads IIN, Claas FHJ Dfferental mmunogencty of paternal HLA class I antgens n pregnant women In: Human Immunol 2003; 64: Bartels MC, Doxads IIN, Colen TP, Beekhus HW Long-term outcome n hgh rsk corneal transplantaton and the nfluence of HLA-A and HLA-B matchng In: Cornea 2003; 22: Roels L, Patrzalek D, Cohen B, Wght C Non-exploted potental for organ donaton: donor acton pre nterventon data and the Polsh case In: Transplant Proc. 2003; 35(3): Dankers MK, Wtvlet M, Roelen DL, Lange de P, Korfage N, Persjn GG, Doxads IIN, Claas FHJ The number of amno acd sequence dfferences between patent and donor s predctve for the antbody response aganst the msmatched HLA antgens In: Hum Immunol., Oct 2003; 64 (10 Suppl): S16 Mulder A, Ejsnk C, Kester M, Kardol MJ, Franke-van Djk ME, Drjfhout JW, Konng F, Doxads IIN, Claas FHJ The mpact of peptdes on the recognton of HLA class I molecules by human HLA antbodes In: Hum Immunol., Oct 2003; 64 (10 Suppl): S22 Doxads IIN, Fjter de J, Mallat M, Lange de P, Rngers J, Paul L, Persjn GG, Claas FHJ Matchng for HLA n cadaverc renal transplantaton revsted: major mpact of the full HLA-DR compatblty allowng smpler and equtable allocaton of organs In: Hum Immunol., Oct 2003; 64 (10 Suppl): S33 Smts JMA, Deng MC, Hummel M, Meester De J, Schoendube F, Scheld HH, Persjn GG, Laufer G, Houwelngen van HC; Comparatve Outcome and Clncal Profles n Transplantaton (COCPIT) Study Group A prognostc model for predctng watng-lst mortalty for a total natonal cohort of adult heart-transplant canddates In: Transplantaton, Oct. 27, 2003; 76 (8): Smts JMA, Mertens BJ, Houwelngen van HC, Haverch A, Persjn GG, Laufer G Predctors of lung transplant survval n Eurotransplant In: Am J Transplant., Nov 2003; 3 (11); Hout van den WB, Smts JM, Deng MC, Hummel M, Schoendube F, Scheld HH, Persjn GG, Laufer G; Comparatve Outcome and Clncal Profles n Transplantaton (COCPIT) Study Group; Eurotransplant heart transplant programs The heart-allocaton smulaton model: a tool for comparson of transplantaton allocaton polces In: Transplantaton, Nov. 27, 2003; 76 (10): Mulder A, Ejsnk C, Kardol MJ, Franke-van Djk ME, Burg van der SH, Kester M, Doxads IIN, Claas FHJ Identfcaton, solaton, and culture of HLA-A2-specfc B lymphocytes usng MHC class I tetramers In: J Immunol., Dec. 15, 2003, 171: Smts JMA, Melman S, Mertens BJA, Laufer G, Persjn GG, Van Raemdonck D The Eurotransplant Study on twn lung transplants (ESOTWIN): 90 pared sngle-lung transplants from the same donor In: Transplantaton, Dec. 15, 2003; 76 (11):

51 A9. Abbrevated Fnancal Statements Balance sheet Assets x 1000 x 1000 Fxed assets Short term recevables Lqud assets Labltes x 1000 x 1000 Equty Reserve funds Short term labltes Statement of ncome and charges Income x 1000 x 1000 Regstraton fees Procurement fees Mscellaneous Charges x 1000 x 1000 Salares Procurement charges General expenses Medcal expenses Transport Housng Deprecaton Mscellaneous Explotaton balance Appropraton of Results Addton Reserve Fund explantaton costs Addton Tarff Equalty Reserve

52 Abbrevated fnancal statements of Stchtng Eurotransplant Internatonal Foundaton, derved from the audted fnancal statements of Stchtng Eurotransplant Internatonal Foundaton for the year ended December 31, 2003 For an understandng of the Foundaton's fnancal poston and results and for an adequate understandng of the scope of our audt, the abbrevated fnancal statements should be read n conjuncton wth the fnancal statements from whch the abbrevated fnancal statements have been derved and our unqualfed audtors' report thereon ssued on May 3, Accountng polces General The accounts are prepared under the hostorcal conventon. Amounts n foregn currences have been converted nto Euro at the rate of the balance date. Income and expenses are accounted for on accrual bass. Proft s only ncluded when realzed. Losses and rsks orgnatng before the end of the fnancal year are taken nto account f they have become known before preparaton of the fnancal statements. Current assets and labltes These are stated at nomnal value. For doubtful accounts a provson has been made. Explotaton balance The explotaton balance s defned as the dfference between ncome and charges based on the above mentoned polces. Charges The general expenses of the Stchtng Eurotransplant Internatonal Foundaton are stated.on the bass of transacton costs. Certan general expenses of the Nederlandse Transplantate Stchtng and Stchtng Eurotransplant Internatonal Foundaton are made for common account. Such costs are dvded between the two foundatons on the bass of actvty-levels. Alteraton of accountng system As from 2003 the provson for renal and non-renal explantaton costs are consdered as reserve-funds nstead of short term labltes. The comparatve fgures of 2002 are adjusted. As a consequence of ths the explotaton balance 2003 s postvely effected by The reserve funds per December 31, 2003 are posetvely effected by Ths alteraton has no effect on the explotaton balance The reserve funds per December 31, 2002 are posetvely effected by Audtor's report We have audted the abbrevated fnancal statements of Stchtng Eurotransplant Internatonal Foundaton, at Leden, for the year ended December 31, These abbrevated fnancal statements have been derved from the fnancal statements of Stchtng Eurotransplant Internatonal Foundaton for the year ended December 31, In our audtor's report dated May 3, 2004 we expressed an unqualfed opnon on these fnancal statements. These abbrevated fnancal statements are the responsblty of the Foundaton's management. Our responsblty s to express an opnon on these abbrevated fnancal statements. In our opnon, these abbrevated fnancal statements are consstent, n all the materal respects, wth the fnancal statements from whch they have been derved. For an understandng of the Foundaton's fnancal poston and results and for an adequate understandng of the scope of our audt, the abbrevated fnancal statements should be read n conjuncton wth the fnancal statements from whch the abbrevated fnancal statements have been derved and our unqualfed audtors' report thereon ssued on May 3, Leden, May 3, 2004 Delotte Accountants 51

53