EUROTRANSPLANT INTERNATIONAL FOUNDATION. Annual Report

EUROTRANSPLANT INTERNATIONAL FOUNDATION Annual Report 2003

EUROTRANSPLANT INTERNATIONAL FOUNDATION 2003 LEGALLY FOUNDED: MAY 12, 1969 Edted by Bernard Cohen, Gudo G. Persjn Central offce P.O. box 2304 2301 CH Leden The Netherlands Tel. +31-71-579 57 95 Fax +31-71-579 00 57 www.eurotransplant.org 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.

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 90-71658-23-6 Trefw.: Eurotransplant Foundaton; jaarverslagen. 2

TABLE OF CONTENTS Board of Eurotransplant Internatonal Foundaton 5 TRANSPLANT AND THEIR DELEGATES IN 2003 6 Renal Programs 6 Heart Programs 7 Lung Programs 8 Lver Programs 9 Pancreas (*Islet) Programs 10 Tssue Typng Laboratores 10 Foreword 13 1. Report of the Board and the central offce of Stchtng Eurotransplant Internatonal Foundaton 14 1.0 General 14 1.1 Polcy 15 1.2 Central offce 20 1.3 Advsory Commttees 21 1.4 Recommendatons approved 23 2. Eurotransplant: donaton, watng lst and transplants n 2002 26 Table 2.1 Number of cadaverc organ donors, from the Eurotransplant regon and used for a transplant from 1999 to 2003 26 Table 2.2 Number of cadaverc organ donors, from the Eurotransplant regon and used for a transplant, by organ from 1999 to 2003 26 Table 2.3 Demographc data on cadaverc organ donors, from the Eurotransplant regon and used for a transplant from 1999 to 2003 27 Table 2.4a Type of cadaverc organ donaton, used n a transplant, from 1999 to 2003 28 Table 2.4b Type of cadaverc organ donaton, used n a transplant, by country of donor orgn for 2003 28 Table 2.4c Non-heart beatng donors 2003 28 Table 2.5 Sze of the actve Eurotransplant watng lst, by organ, as per December 31, from 1999 to 2003 28 Table 2.6 Regstratons on the Eurotransplant watng lst, by organ from 1999 to 2003 29 Table 2.7 Number of transplanted organs wthn Eurotransplant area, by organ, by donor type from 1999 to 2003 30 Table 2.8 Transplants n the Eurotransplant regon, from 1999 to 2003 30 Table 2.9 Mortalty on the Eurotransplant Watng Lst, from 1999 to 2003 30 3. Kdney: donaton, watng lsts, and transplants 31 Table 3.1 Cadaverc donor kdneys n the Eurotransplant regon n 2003 31 Table 3.2 Actve cadaverc kdney transplant watng lst as per December 31, 2003 - characterstcs 31 Table 3.3 Actve cadaverc kdney transplant watng lst as per December 31, 2003 - characterstcs 31 Table 3.4 Kdney transplants characterstcs - 2003 32 Fgure 3.1 Dynamcs of the Eurotransplant kdney transplant watng lst and transplants between 1969 and 2003 33 Table 3.5 Lvng donor kdney transplants - kds only - 2003 33 4. Thoracc organs: donaton, watng lsts, and transplants 34 Table 4.1 Cadaverc donor hearts n the Eurotransplant regon n 2003 34 Table 4.2 Cadaverc donor lungs n the Eurotransplant regon n 2003 34 3

Table 4.3 Actve cadaverc heart transplant watng lst as per December 31, 2003 - characterstcs 34 Table 4.4 Actve cadaverc heart transplant watng lst as per December 31, 2003 - characterstcs 35 Table 4.5 Actve heart + lung transplant watng lst as per December 31, 2003 - characterstcs 35 Table 4.6 Actve cadaverc heart + lung transplant watng lst as per December 31, 2003 - characterstcs 35 Fgure 4.1 Dynamcs of the Eurotransplant heart watng lst and transplants betweeen 1991 and 2003 35 Table 4.7 Actve lung transplant watng lst as per December 31, 2003 - characterstcs 36 Table 4.8 Actve cadaverc lung transplant watng lst as per December 31, 2003 - characterstcs 36 Table 4.9 Heart transplants 2003 - characterstcs 36 Table 4.10 Heart + lung transplants 2003 - 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 2003 37 Table 4.11 Lung transplants 2003 - characterstc 38 5. Lver: donaton, watng lsts, and transplants 39 Table 5.1 Cadaverc donor lvers n the Eurotransplant regon n 2003 39 Table 5.2 Actve cadaverc lver transplant watng lst as per December 31, 2003 - characterstcs 39 Table 5.3 Actve cadaverc lver transplant watng lst as per December 31, 2003 - characterstcs 40 Table 5.4 Lver transplants 2003 - characterstcs 40 Table 5.5 Lvng donor lver transplants - lver only 2003 40 Intestne transplants 41 Fgure 5.1 Dynamcs of the Eurotransplant lver watng lst and lver transplants between 1991 and 2003 41 6. Pancreas: donaton, watng lsts, and transplants 42 Table 6.1 Cadaverc donor pancreas n the Eurotransplant regon n 2003 42 Table 6.2 Actve cadaverc pancreas transplant watng lst as per December 31, 2003 - characterstcs 42 Table 6.3a Actve cadaverc pancreas only transplant watng lst as per December 31, 2003 - characterstcs 42 Table 6.3b Actve cadaverc kdney+pancreas transplant watng lst as per December 31, 2003 - characterstcs 43 Table 6.4a Pancreas transplants 2003 - characterstcs 43 Table 6.4b Number of pancreas slet transplantatons 2003 43 Table 6.4c Pancreas transplants 2003 - 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 2003 44 7. Hstocompatblty Testng 45 7.1 Introducton 45 7.2 Eurotransplant External Profcency Testng (EPT) Schemes 45 7.2.1 External Profcency Testng on HLA typng 45 7.2.2 External Profcency Testng Exercses on molecular typng 45 7.2.3 External Profcency Testng on Crossmatchng 46 7.2.4 External Profcency Testng Exercse on Screenng 46 7.3 Programmes for the hghly senstsed patents n Eurotransplant 46 7.4 Other actvtes 47 Fgure 7.1. Transplanted AM patents 47 Fgure 7.2. Patents n the AM watng lst per 01.01.2004 47 8. Publcatons n 2003 48 8.1 Publcatons 48 9. Abbrevated Fnancal Statements 50 4

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

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

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

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

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

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

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

12

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 www.eurotransplant.nl. 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 2004 13

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, 2003. 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, 2003. 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 2004. 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 2005. 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

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 2003. 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

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 2003. Gradual mplementaton of the MELD score was one of the most mportant topcs of dscusson n the ELAC and resulted n acceptance of RLAC01.03. 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

Eurotransplant Computer Servces Workng Group (CSWG) The CSWG was nformed on IT projects that were completed, under constructon or to be started n 2003. 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

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

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

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 2004. 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 2003. 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). - 65 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). - 83 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

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 2003. 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 01.1997 charman, representatve Board Prof.Dr. G. Mayer, Innsbruck 12.2000 representatve Austra Prof.Dr. F. Mühlbacher, Venna 09.1994 representatve Austra Dr. P. Duhoux, Luxembourg 09.1994 representatve Luxembourg Dr. D. Abramowcz, Brussels (BR) 01.2000 representatve Belgum Prof.Dr. J-P. Squfflet, Brussels (LA) 09.1999 representatve Belgum Prof.Dr. G. Offermann, Berln 09.1994 representatve Germany Prof.Dr. K. Drekorn, Bremen 12.1996 representatve Germany Prof.Dr. U. Heemann, Munch 01.2002 representatve Germany Prof.Dr. U. Kunzendorf, Kel 01.2002 representatve Germany Dr. R. Hené, Utrecht 03.1998 representatve the Netherlands Dr. J. de Fjter, Leden 01.2002 representatve the Netherlands Dr. D. Kovac, Ljubljana 12.1999 representatve Slovena Prof.Dr. F.H.J. Claas, Leden (ETRL) 09.1994 representatve TT Assembly Dr. G.G. Persjn, Eurotransplant 09.1994 secretary LIVER ADVISORY COMMITTEE (ELAC) Name As of Remarks Prof.Dr. J. Hauss, Lepzg 11.2001 charman, representatve Board Prof.Dr. A. Köngsraner, Innsbruck 10.2001 representatve Austra Dr. O. Detry, Lège 01.2000 representatve Belgum Prof.Dr. J. Lerut, Brussels (LA) 01.2000 representatve Belgum Prof.Dr. P. Neuhaus, Berln 09.1994 representatve Germany Prof.Dr. K-W. Jauch, Munch 01.2002 representatve Germany Prof.Dr. X. Rogers, Hamburg 01.2002 representatve Germany Dr. B. van Hoek, Leden 07.2001 representatve the Netherlands Dr. D. Stansavljevc, Ljubljana 01.2000 representatve Slovena Dr. T. Gerlng, Eurotransplant 03.2001 secretary PANCREAS ADVISORY COMMITTEE (PAC) Name As of Remarks Prof.Dr. J.P. van Hooff, Maastrcht 06.1998 charman, representatve Board Prof.Dr. A. Köngsraner, Innsbruck 08.1994 representatve Austra Prof.Dr. J-P. Squfflet, Brussels (LA) 08.1994 representatve Belgum Prof.Dr. W. Bechsten, Bochum 01.2000 representatve Germany Prof.Dr. R.G. Bretzel, Gessen 09.1996 representatve Germany Prof.Dr. W. Schareck, Rostock 01.2000 representatve Germany Dr. J. Rngers, Leden 04.1998 representatve the Netherlands Prof.Dr. R.J. Ploeg, Gronngen 10.2001 representatve the Netherlands Prof.Dr. F.H.J. Claas, Leden (ETRL) 08.1994 representatve TT Assembly Dr. K. Djkstra, Eurotransplant 01.2001 secretary 21

THORACIC ADVISORY COMMITTEE (ThAC) Name As of Remarks Prof.Dr. G. Laufer, Innsbruck 10.2001 charman, representatve Board Prof.Dr. A. Wasler, Graz 11.2001 representatve Austra Prof.Dr. W. Klepetko, Venna 05.2000 representatve Austra Dr. M. Antone, Brussels (BR) 01.2000 representatve Belgum Prof.Dr. D. Van Raemdonck, Leuven 02.2001 representatve Belgum Dr. B. Meser, Munch 01.2000 representatve Germany Prof.Dr. W. Mohr, Lepzg 01.2000 representatve Germany Prof.Dr. H-G. Feguth, Frankfurt 04.2002 representatve Germany Prof.Dr. R. Hetzer, Berln 04.2002 representatve Germany Dr. A. Balk, Rotterdam 03.1998 representatve the Netherlands Dr. W. van der Bj, Gronngen 06.2001 representatve the Netherlands Dr. R. Blumauer, Ljubljana 07.2002 representatve Slovena Dr. J. Smts, Eurotransplant 07.2002 (nterm) secretary Dr. G. Persjn, Eurotransplant 07.2002 (nterm) secretary ORGAN PROCUREMENT COMMITTEE (OPC) Name As of Remarks Prof.Dr. W.O. Bechsten, Frankfurt 12.2003 charman, representatve Board Dr. P. Wamser, Venna 03.1995 representatve TC s Austra Mr. L. Colenbe, Gent 01.2002 representatve TC s Belgum Mr. D. Horch, Berln 01.2000 representatve TC s Germany Dr. D. Bösebeck, Munch 01.2002 representatve TC s Germany Mr. W. Hordjk, Njmegen 11.1998 representatve TC s NL Dr. T. Pntar, Ljubljana 05.2000 representatve Slovena Prof.Dr. J-P. Squfflet, Brussels (LA) 01.2002 representatve ETKAC Dr. O. Detry, Lège 01.2000 representatve ELAC Dr. J. Rngers, Leden 04.2002 representatve PAC Dr. M. Antone, Brussels (BR) 06.1998 representatve ThAC Dr. I. Doxads, Leden (ETRL) 02.1998 representatve TTAC Dr. J. de Boer, Eurotransplant 09.1995 secretary COMPUTER SERVICES WORKING GROUP (CSWG) Name As of Remarks Prof.Dr. F. Mühlbacher, Venna 09.1995 charman, representatve Board + ETKAC Dr. R. Kramar, Wels 09.1995 representatve Austra Mr. F. Van Gelder, Leuven 01.2002 representatve Belgum Dr. F. Zantvoort, Bremen 01.2002 representatve Germany Dr. A. Hotsma, Njmegen 09.1995 representatve the Netherlands Dr. B. van Hoek 04.2002 representatve ELAC Dr. W. van der Bj, Gronngen 05.2002 representatve ThAC Dr. S. Lems, Gronngen 06.1996 representatve TTAC Mr. W. van Zwet, Eurotransplant 11.2000 secretary TISSUE TYPING ADVISORY COMMITTEE (TTAC) Name As of Remarks Prof.Dr. F.H.J. Claas, Leden (ETRL) 09.1995 charman, representatve Board Prof.Dr. W. Mayr, Venna 09.1995 representatve Austra Prof.Dr. D. Latnne, Brussels (LA) 01.2000 representatve Belgum Dr. F. Hentges, Luxembourg 09.1995 representatve Luxembourg Prof.Dr. R. Wassmuth, Düsseldorf 01.2000 representatve Germany Dr. C. Schönemann, Berln 11.2002 representatve Germany Dr. S. Lems, Gronngen 09.1995 representatve the Netherlands Dr. B. Vdan Jeras, Ljubljana 12.1999 representatve Slovena Prof.Dr. I.I.N. Doxads, Leden (ETRL) 09.1995 secretary ETHICS COMMITTEE (EC) Name As of Remarks Prof.Dr. P. Schotsmans, Leuven 01.2001 charman, representatve Board Drs. M. Bos, The Hague 05.1995 vce-charman, reperesentatve the Netherlands Prof. Redng, Brussels (LA) 01.2000 representatve Belgum Prof.Dr. G. Gubernats, Hanover 11.2002 representatve Germany 22

Dr. W. Schaupp, Venna 04.1998 representatve Austra Dr. D. Rgler Pletersk, Ljubljana 01.2000 representatve Slovena Dr. G.C. Wesenhaan-Stellngwerff, ET 04.2001 secretary FINANCIAL COMMITTEE (FC) Name As of Remarks Prof.Dr. A.P.W.P. van Montfort 31.2003 charman, representatve Board Mag. O. Postl, Venna 05.1995 representatve Austra Dr. D. Ysebaert, Antwerp 05.1995 representatve Belgum Prof.Dr. U. Albert, Kaserslautern 01.22002 representatve Germany Dr. B. Cohen, Eurotransplant 05.1995 secretary 1 W. van Zwet, Eurotransplant 01.1999 secretary 2 1.4 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. RLAC02.03 1. 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

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 RPAC05.01 2nd 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

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 2002. 25

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 1999 2000 2001 2002 2003 pmp 2002/2003 (mllon) Austra 8.2 203 186 189 195 187 22.8-4.1 % Belgum 10.3 242 258 222 223 248 24.1 11.2 % Germany 82.2 1009 995 1051 1001 1110 13.5 10.9 % Luxembourg 0.4 8 7 5 3 8 20.0 166.7 % Netherlands 16.0 165 202 187 202 223 13.9 10.4 % Slovena 2.0 0 22 23 35 28 14.0-20.0 % total 119 1627 1670 1677 1659 1804 15.1 8.7 % 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 1999 2000 2001 2002 2003 2002/2003 organ donors, total 1627 1670 1677 1659 1804 8.2 % organ donors, by organ Sum: kdney 1578 1632 1623 1590 1748 9.9 % heart 709 633 593 592 578-2.4 % lung 220 244 241 324 339 4.6 % lver 1027 1076 1054 1064 1176 10.5 % pancreas 310 334 313 331 366 10.6 % Number of cadaverc organ donors, from the Eurotransplant regon and used for a transplant, by organ and country from 1999 to 2003 kdney 1999 2000 2001 2002 2003 2002/2003 Austra 199 185 182 192 179-6.8 % Belgum 229 249 206 196 231 17.9 % Germany 977 969 1021 972 1083 11.4 % Luxembourg 8 7 5 3 8 166.7 % Netherlands 165 200 186 194 219 12.9 % Slovena 0 22 23 33 28-15.2 % total 1578 1632 1623 1590 1748 9.9 % heart 1999 2000 2001 2002 2003 2002/2003 Austra 94 88 70 79 70-11.4 % Belgum 119 116 91 95 92-3.2 % Germany 441 369 374 348 341-2.0 % Luxembourg 3 1 4 0 5 % Netherlands 52 48 42 49 58 18.4 % Slovena 0 11 12 21 12-42.9 % total 709 633 593 592 578-2.4 % lver 1999 2000 2001 2002 2003 2002/2003 Austra 144 142 126 143 133-7.0 % Belgum 183 195 192 176 206 17.0 % Germany 591 589 608 609 701 15.1 % Luxembourg 6 4 4 3 7 133.3 % Netherlands 103 129 106 112 108-3.6 % Slovena 0 17 18 21 21 % total 1027 1076 1054 1064 1176 10.5 % 26

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 1999 2000 2001 2002 2003 2002/2003 lung 1999 2000 2001 2002 2003 2002/2003 Austra 45 44 40 62 51-17.7 % Belgum 38 54 47 47 63 34.0 % Germany 113 113 124 175 181 3.4 % Luxembourg 1 0 0 0 1 % Netherlands 23 29 24 28 34 21.4 % Slovena 0 4 6 12 9-25.0 % total 220 244 241 324 339 4.6 % pancreas 1999 2000 2001 2002 2003 2002/2003 Austra 32 31 27 44 33-25.0 % Belgum 57 56 56 75 93 24.0 % Germany 194 209 190 181 198 9.4 % Luxembourg 2 2 4 1 3 200.0 % Netherlands 25 28 33 26 30 15.4 % Slovena 0 8 3 4 9 125.0 % total 310 334 313 331 366 10.6 % Table 2.3 Demographc data on cadaverc organ donors, from the Eurotransplant regon and used for a transplant from 1999 to 2003 age 1999 2000 2001 2002 2003 % 2002-2003 0-15 100 90 89 70 92 5.1 % 31.4 % 16-55 1068 1104 1098 1083 1160 64.3 % 7.1 % 56-64 275 304 273 283 296 16.4 % 4.6 % >=65 184 172 217 220 256 14.2 % 16.4 % not reported 0 0 0 3 0-100.0 % total 1627 1670 1677 1659 1804 100.0 % 8.7 % sex 1999 2000 2001 2002 2003 % 2002-2003 female 693 727 735 714 818 45.3 % 14.6 % male 934 943 942 945 986 54.7 % 4.3 % total 1627 1670 1677 1659 1804 100.0 % 8.7 % blood group 1999 2000 2001 2002 2003 % 2002-2003 A 721 710 724 738 814 45.1 % 10.3 % AB 65 68 76 78 78 4.3 % 0.0 % B 179 168 184 177 180 10.0 % 1.7 % O 662 724 693 666 732 40.6 % 9.9 % total 1627 1670 1677 1659 1804 100.0 % 8.7 % cause of death 1999 2000 2001 2002 2003 % 2002-2003 accdent 516 481 522 459 473 26.2 % 3.1 % natural 1002 1090 1074 1115 1229 68.1 % 10.2 % sucde 70 68 63 67 66 3.7 % -1.5 % other 39 31 18 18 36 2.0 % 100.0 total 1627 1670 1677 1659 1804 100.0 % 8.7 % 27

Table 2.4a Type of cadaverc organ donaton, used n a transplant, from 1999 to 2003 1999 2000 2001 2002 2003 % 2002/2003 kdney donor SOD 484 473 504 475 515 29.3 % 8.4 % MOD 1114 1176 1137 1121 1241 70.7 % 10.7 % kdney donor total 1598 1649 1641 1596 1756 100.0 % 10.0 % non-kdney donor SOD 115 83 78 126 115 82.7 % -8.7 % MOD 29 16 13 25 24 17.3 % -4.0 % non-kdney donor total 144 99 91 151 139 100.0 % -7.9 % total 1742 1748 1732 1747 1895 100.0 % 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 39 140 78.2% 179 7 1 12.5% 8 187 9.9 % Belgum 25 206 89.2% 231 12 5 29.4% 17 248 13.1 % Germany 335 748 69.1% 1083 21 6 22.2% 27 1110 58.6 % Luxembourg 1 7 87.5% 8 0 0 0,0% 0 8 0.4 % Netherlands 102 117 53.4% 219 1 3 75.0% 4 223 11.8 % Slovena 7 21 75.0% 28 0 0 0,0% 0 28 1.5 % non ET 6 2 25.0% 8 74 9 10.8% 83 91 4.8 % total 515 1241 70.7% 1756 115 24 17.3% 139 1895 100.0 % 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 1 0 1 2 II- unsuccesful resusctaton 0 1 15 16 III - awatng heart arrest 1 11 94 106 IV - heart arrest n bran death donor 0 2 0 2 total 2 14 110 126 Table 2.5 Sze of the actve Eurotransplant watng lst, by organ, as per December 31, from 1999 to 2003 watng lst type composton 1999 2000 2001 2002 2003 2002/2003 heart heart 607 485 419 418 556 33.0 % heart + lver 0 0 0 1 0-100.0 % heart + lver + lung 0 0 0 1 0-100.0 % heart + lung 46 42 43 42 45 7.1 % kdney + heart 2 4 5 4 12 200.0 % total 655 531 467 466 613 31.5 % watng lst type composton 1999 2000 2001 2002 2003 2002/2003 kdney kdney 12080 12293 12268 12371 12132-1.9 % kdney + heart 2 4 5 4 12 200.0 % kdney + lver 30 28 32 58 60 3.4 % kdney + lver + pancreas 1 3 0 1 2 100.0 % kdney + pancreas 199 195 144 219 176-19.6 % kndey + lung 1 1 1 0 0 0.0% total 12313 12524 12450 12653 12382-2.1 % 28

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 1999 2000 2001 2002 2003 2002/2003 lver lver 558 765 1042 1296 1644 26.9 % heart + lver 0 0 0 1 0-100.0 % heart + lver + lung 0 0 0 1 0-100.0 % kdney + lver 29 28 32 58 60 3.4 % kdney + lver + pancreas 1 3 0 1 2 100.0 % lver + lung 4 3 7 3 4 33.3 % lver + pancreas 1 4 12 6 4-33.3 % total 593 803 1093 1366 1714 25.5 % watng lst type composton 1999 2000 2001 2002 2003 2002/2003 lung lung 345 373 422 459 513 11.8 % heart + lver + lung 0 0 0 1 0-100.0 % heart + lung 46 42 43 42 45 7.1 % kndey + lung 1 1 1 0 0 0.0% lver + lung 4 3 7 3 4 33.3 % total 396 419 473 505 562 11.3 % watng lst type composton 1999 2000 2001 2002 2003 2002/2003 pancreas pancreas 68 87 70 64 75 17.2 % kdney + lver + pancreas 1 3 0 1 2 100.0 % kdney + pancreas 192 195 144 219 176-19.6 % lver + pancreas 1 4 12 6 4-33.3 % total 262 289 226 290 257-11.4 % total 14219 14566 14709 15280 15528 3.9 % Table 2.6 Regstratons on the Eurotransplant watng lst, by organ from 1999 to 2003 All regstraton events 1999 2000 2001 2002 2003 2002/2003 kdney 5450 5300 5191 5328 5122-3.9 % heart 1119 975 926 899 1083 20.5 % lung 512 464 484 609 628 3.1 % lver 1663 1923 2033 2192 2427 10.7 % pancreas 427 437 361 456 387-15.1 % New regstratons 1999 2000 2001 2002 2003 2002/2003 kdney 4598 4553 4432 4534 4370-3.6 % heart 1091 951 901 870 1052 20.9 % lung 488 443 459 574 587 2.3 % lver 1475 1696 1773 1972 2140 8.5 % pancreas 387 401 324 377 302-19.9 % Re - regstratons 1999 2000 2001 2002 2003 2002/2003 kdney 852 747 759 794 752-5.3 % heart 28 24 25 29 31 6.9 % lung 24 21 25 35 41 17.1 % lver 188 227 260 220 287 30.5 % pancreas 40 36 37 79 85 7.6 % 29

Table 2.7 Number of transplanted organs wthn Eurotransplant area, by organ, by donor type from 1999-2003 cadaver 1999 2000 2001 2002 2003 2002/2003 kdney 3096 3175 3150 3063 3378 10.3 % heart 737 643 596 598 590-1.3 % lung 452 463 465 665 713 7.2 % lver 1135 1169 1112 1132 1258 11.1 % pancreas 308 338 311 344 379 10.2 % total 5728 5788 5634 5802 6318 8.9 % lvng 1999 2000 2001 2002 2003 2002/2003 kdney 580 569 619 698 646-7.4 % heart * 0 1 2 0 0 0.0 % lung 2 0 0 0 0 0.0 % lver * 64 116 124 129 133 3.1 % total 646 686 745 827 779-5.8 % * domno Table 2.8 Transplants n the Eurotransplant regon, from 1999-2003 Cadaverc Donors 1999 2000 2001 2002 2003 2002/2003 Heart 703 619 568 566 559-1.2 % Kdney 2740 2800 2809 2783 3046 9.5 % Sngle lung 81 92 79 93 97 4.3 % Both lungs 153 164 168 258 281 8.9 % Lver 993 1012 1002 1005 1080 7.5 % Splt lver 105 113 72 79 129 63.3 % Heart + kdney 4 4 7 8 7-12.5 % Heart + both lungs 27 18 21 24 21-12.5 % Heart + lver 1 0 0 0 1 -- Kdney + lung 1 0 0 0 0 -- Kdney + both lungs 0 0 1 1 0-100.0 % Kdney + lver 24 31 29 37 32-13.5 % Kdney + splt lver 1 3 3 2 8 300.0 % Lver + both lungs 4 2 3 2 4 100.0 % Splt lver + both lungs 0 0 0 1 0-100.0 % Heart + both lungs + kdney 0 0 0 0 1 -- Heart + both lungs + lver 1 1 0 0 1 -- Heart + kdney + lver 1 0 0 0 0 -- Heart + sngle lung 0 1 0 0 0 -- Panceas 16 25 37 39 36-7.7 % Pancreas + kdney 287 306 271 208 247 18.8 % Pancreas + lver 5 4 3 5 2-60.0 % Pancreas + splt lver 0 1 0 0 0 -- Pancrea + lver + kdney 0 2 0 0 1 -- Pancreas slets 0 0 0 46 32-30.4 % Pancreas slets + lver 0 0 0 1 0-100.0 % Pancreas slets + kdney 0 0 0 4 3-25.0 % Total 5147 5198 5073 5162 5588 8.25 % Lvng Donors 1999 2000 2001 2002 2003 2002/2003 Heart 0 1 2 0 0 -- Kdney 580 569 619 698 646-7.4 % Lver 64 116 124 125 131 4.8 % Lung 2 0 0 0 0 -- Splt lver 0 0 0 4 2-50.0 % Total 646 686 745 827 779-5.8 % Type of donor 1999 2000 2001 2002 2003 2002/2003 Cadaverc donors 5147 5198 5073 5162 5588 8,25 % Lvng donors 646 686 745 827 779-5,8 % Total 5793 5884 5818 5989 6367 6,3 % Table 2.9 Mortalty on the Eurotransplant Watng Lst, from 1999-2003 1999 2000 2001 2002 2003 kdney 590 618 595 621 646 heart 251 182 203 178 194 lung 120 107 123 112 118 lver 214 279 304 363 410 pancreas 25 32 30 26 20 total 1200 1218 1255 1300 1388

KTable 3.1 Cadaverc donor kdneys n the Eurotransplant regon n 2003 3. Kdney: donaton, watng lsts, and transplants Donors donor country Austra Belgum Germany Luxembourg Netherlands Slovena total cadaverc donors 196 258 1163 8 258 29 1912 not kdney donors 7 7 20 0 3 0 37 cadaverc kdney donors 189 251 1143 8 255 29 1875 Kdneys donor country Austra Belgum Germany Luxembourg Netherlands Slovena total potental kdneys 378 502 2286 16 510 58 3750 kdneys not reported 2 3 10 0 2 0 17 reported kdneys 376 499 2276 16 508 58 3733 kdneys not procured 10 29 69 0 50 2 160 procured kdneys 366 470 2207 16 458 56 3573 kdneys not transplanted 18 25 104 1 52 3 203 kdneys transplanted 348 445 2103 15 406 53 3370 Table 3.2 Actve cadaverc kdney transplant watng lst as per December 31, 2003 - characterstcs Type of transplant Austra Belgum Germany Luxembourg Netherlands Slovena total % kdney 739 814 9315 20 1169 75 12132 98.0 % kdney+heart 5 1 6 0 0 0 12 0.1 % kdney+lver 4 12 41 0 3 0 60 0.5 % kdney+lver+pancreas 0 1 1 0 0 0 2 0.0 % kdney+pancreas 26 24 116 0 10 0 176 1.4 % total 774 852 9479 20 1182 75 12382 100.0 % Table 3.3 Actve cadaverc kdney only transplant watng lst as per December 31, 2003 - characterstcs blood group % PRA current sequence tme watng (dalyss) (years) not not pre year A AB B O reported 0-5% 6-84% 85-100% reported frst repeat emptve 0-1 2-4 5+ 2003 4679 268 1306 5879 0 10851 1141 117 23 10248 1884 226 3021 5895 2989 % 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% 2002 4862 274 1297 5938 0 11004 1196 110 61 10449 1922 196 3236 6040 2899 % 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% 2001 4889 281 1258 5839 1 10921 1194 101 52 10396 1872 205 3226 6032 2805 % 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% 2000 4846 262 1268 5917 0 10880 1286 104 23 10355 1938 144 3430 5972 2747 % 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

Table 3.4 Kdney transplants characterstcs - 2003 Cadaverc donor kdney transplants type of transplant Austra Belgum Germany Luxembourg Netherlands Slovena non ET total % kdney only 299 383 1892 9 387 43 7 3020 90.1 % kdney en bloc 3 10 19 0 1 0 0 33 1.0 % kdney + pancreas 33 29 172 0 16 0 0 250 7.5 % kdney + heart 2 2 3 0 0 0 0 7 0.2 % kdney + splt lver 0 1 7 0 0 0 0 8 0.2 % kdney + whole lver 5 9 16 0 2 0 0 32 1.0 % kdney + heart + both lungs 0 0 1 0 0 0 0 1 0.0 % kndey + pancreas + whole lver 0 0 1 0 0 0 0 1 0.0 % total 342 434 2111 9 406 43 7 3352 100.0 % Kdney only transplant (ncludng kdney en bloc) HLA - A, B, DR msmatches Austra Belgum Germany Luxembourg Netherlands Slovena non ET total % 0 31 44 414 2 52 2 0 545 17.9 % 1 16 39 141 0 51 7 0 254 8.3 % 2 68 122 445 3 117 10 0 765 25.1 % 3 103 149 487 2 127 20 0 888 29.1 % 4 54 34 223 2 34 4 0 351 11.5 % 5 12 4 152 0 6 0 0 174 5.7 % 6 5 1 43 0 1 0 0 50 1.6 % not calculated 13 0 6 0 0 0 7 26 0.9 % total 302 393 1911 9 388 43 7 3053 100.0 % blood group Austra Belgum Germany Luxembourg Netherlands Slovena non ET total % A 137 168 909 4 161 17 3 1399 45.8 % AB 17 18 110 0 23 1 2 171 5.6 % B 38 38 225 1 53 11 2 368 12.1 % O 110 169 667 4 151 14 0 1115 36.5 % total 302 393 1911 9 388 43 7 3053 100.0 % PRA Austra Belgum Germany Luxembourg Netherlands Slovena non ET total % 0-5% 247 352 1725 9 347 37 3 2720 89.1 % 6-84% 51 36 167 0 33 6 0 293 9.6 % 85-100% 2 5 19 0 8 0 0 34 1.1 % not reported 2 0 0 0 0 0 4 6 0.2 % total 302 393 1911 9 388 43 7 3053 100.0 % wat (months) (dalyss) Austra Belgum Germany Luxembourg Netherlands Slovena non ET total % 0-5 8 14 19 0 6 0 7 54 1.8 % 6-11 19 30 59 1 6 2 0 117 3.8 % 12-23 55 117 137 3 39 3 0 354 11.6 % 24-59 174 187 522 5 226 21 0 1135 37.2 % 60 + 42 37 1169 0 108 17 0 1373 45.0 % pre emptve 4 8 5 0 3 0 0 20 0.7 % total 302 393 1911 9 388 43 7 3053 100.0 % sequence Austra Belgum Germany Luxembourg Netherlands Slovena non ET total % frst 248 330 1594 9 319 43 7 2550 83.5 % repeat 54 63 317 0 69 0 0 503 16.5 % total 302 393 1911 9 388 43 7 3053 100.0 % 32

14000 12000 10000 8000 6000 4000 2000 0 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1991 1993 1995 1997 1998 1999 2000 2001 2002 2003 Kdney watng lst 450 892 1147 1200 934 1929 2135 2928 5150 6740 8376 9418 1051 1132 1197 1231 1252 1245 1265 1238 Lvng donor transplants 9 5 11 33 33 33 53 108 150 161 129 127 212 411 526 579 569 617 697 638 Cadaverc donor transplants 102 228 454 583 800 1050 1263 1645 1965 2665 3395 3293 3064 3110 3068 3050 3145 3121 3047 3337 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 - 2003 kdney only Austra Belgum Germany Netherlands total % related 29 9 245 134 417 64.6 % non related 8 1 159 61 229 35.4 % total 37 10 404 195 646 100.0 % Related Austra Belgum Germany Netherlands total % blood related: NOS * 0 0 2 0 2 0.5 % brother / sster 12 3 89 62 166 39.8 % father 4 1 48 24 77 18.5 % grand father / - mother 2 0 0 0 2 0.5 % mother 9 4 86 25 124 29.7 % nephew / nece 2 1 8 3 14 3.4 % son / daughter 0 0 8 18 26 6.2 % uncle / aunt 0 0 4 2 6 1.4 % total 29 9 245 134 417 100.0 % Non related Austra Belgum Germany Netherlands total % other 1 0 28 18 47 20.5 % spouse 7 1 131 43 182 79.5 % total 8 1 159 61 229 100.0 % * Not otherwse specfed 33

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 196 258 1163 8 258 29 1912 not heart donors 77 98 595 2 150 11 933 cadaverc heart donors 119 160 568 6 108 18 979 Hearts donor country Austra Belgum Germany Luxembourg Netherlands Slovena total reported 119 160 568 6 108 18 979 not procured 23 27 85 1 10 3 149 procured 96 133 483 5 98 15 830 not transplanted 26 41 142 0 40 3 252 transplanted 70 92 341 5 58 12 578 Table 4.2 Cadaverc donor lungs n the Eurotransplant regon n 2003 Donors donor country Austra Belgum Germany Luxembourg Netherlands Slovena total cadaverc donors 196 258 1163 8 258 29 1912 not lung donors 95 166 823 7 192 13 1296 cadaverc lung donors 101 92 340 1 66 16 616 Lungs donor country Austra Belgum Germany Luxembourg Netherlands Slovena total potental lungs 202 184 680 2 132 32 1232 not reported 3 6 7 0 3 2 21 reported lungs 199 178 673 2 129 30 1211 not procured 93 56 290 60 14 513 procured 106 122 383 2 69 16 698 not transplanted 7 7 39 0 6 1 60 transplanted 99 115 344 2 63 15 638 Table 4.3 Actve cadaverc heart transplant watng lst as per December 31, 2003 - characterstcs type of transplant Austra Belgum Germany Netherlands Slovena total % heart 55 29 430 33 9 556 90.7 % heart+lung 3 3 37 2 0 45 7.3 % kdney+heart 5 1 6 0 0 12 2.0 % total 63 33 473 35 9 613 100.0 % 34

Table 4.4 Actve cadaverc heart transplant watng lst as per December 31, 2003 - characterstcs blood group sequence tme watng (regstraton months) not year A AB B O reported frst repeat 0-5 6-11 12-23 24 + 2003 270 12 60 214 0 538 18 319 144 80 8 % 48.6% 2.2% 10.8% 38.5% 0.0% 96.8% 3.2% 57.4% 25.9% 14.4% 1.4% 2002 215 16 44 143 0 404 14 255 110 48 5 % 51.4% 3.8% 10.5% 34.2% 0.0% 96.7% 3.3% 61.0% 26.3% 11.5% 1.2% 2001 214 21 35 149 0 408 11 238 123 45 13 % 51.1% 5.0% 8.4% 35.6% 0.0% 97.4% 2.6% 56.8% 29.4% 10.7% 3.1% 2000 205 15 56 209 0 476 9 283 107 78 17 % 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, 2003 - characterstcs type of transplant Austra Belgum Germany Netherlands total % heart+lung 3 3 37 2 45 100.0 % total 3 3 37 2 45 100.0 % Table 4.6 Actve cadaverc heart + lung only transplant watng lst as per December 31, 2003 - characterstcs blood group sequence tme watng (regstraton months) not year A AB B O reported frst repeat 0-5 6-11 12-23 24 + 2003 16 2 3 24 0 45 0 11 14 9 7 % 35.6% 4.4% 6.7% 53.3% 0.0% 100.0% 0.0% 24.4% 31.1% 20.0% 15.6% 2002 12 3 4 23 0 42 0 8 11 9 14 % 28.6% 7.1% 9.5% 54.8% 0.0% 100.0% 0.0% 19.0% 26.2% 21.4% 33.3% 2001 18 0 2 23 0 43 0 18 6 6 13 % 41.9% 0.0% 4.7% 53.5% 0.0% 100.0% 0.0% 41.9% 14.0% 14.0% 30.2% 2000 15 1 2 24 0 42 0 13 8 4 17 % 35.7% 2.4% 4.8% 57.1% 0.0% 100.0% 0.0% 31.0% 19.0% 9.5% 40.5% 900 800 700 600 500 400 300 200 100 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Actve watng lst 499 552 672 723 709 744 744 721 609 489 424 423 568 Heart transplants 806 753 773 696 732 759 782 759 708 623 596 580 590 Fgure 4.1. Dynamcs of the Eurotransplant heart watng lst and transplants betweeen 1991 and 2003 35

Table 4.7 Actve lung transplant watng lst as per December 31, 2003 - characterstcs type of transplant Austra Belgum Germany Netherlands total % lung 34.0 56.0 357.0 66.0 513 91.3 % heart + lung 3.0 3.0 37.0 2.0 45 8.0 % lver + lung 0 0 3.0 1.0 4 0.7 % total 37 59 397 69 562 100.0 % Table 4.8 Actve cadaverc lung only transplant watng lst as per December 31, 2003 - characterstcs blood group sequence tme watng (regstraton months) not year A AB B O reported frst repeat 0-5 6-11 12-23 24 + 2003 158 15 64 276 0 496 17 198 124 124 58 % 30.8% 2.9% 12.5% 53.8% 0.0% 96.7% 3.3% 38.6% 24.2% 24.2% 11.3% 2002 151 8 39 261 0 449 10 201 114 92 43 % 32.9% 1.7% 8.5% 56.9% 0.0% 97.8% 2.2% 43.8% 24.8% 20.0% 9.4% 2001 149 9 38 226 0 410 12 146 112 94 61 % 35.3% 2.1% 9.0% 53.6% 0.0% 97.2% 2.8% 34.6% 26.5% 22.3% 14.5% 2000 139 15 26 193 0 363 10 143 81 107 34 % 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 2003 - characterstcs Cadaverc donor heart transplants type of transplant Austra Belgum Germany Netherlands Slovena non ET total % heart only 60 85 371 40 3 3 562 94.8 % kdney + heart 2 2 3 0 0 0 7 1.2 % heart + both lungs 1 1 18 1 0 0 21 3.5 % heart + kdney + both lungs 0 0 1 0 0 0 1 0.2 % heart + whole lver + both lungs 0 0 1 0 0 0 1 0.2 % heart + whole lver 0 1 0 0 0 0 1 0.2 % total 63 89 394 41 3 3 593 100.0 % Heart only transplant blood group Austra Belgum Germany Netherlands Slovena non ET total % A 26 39 172 18 0 2 257 45.7 % AB 4 4 25 2 0 0 35 6.2 % B 10 3 46 8 2 0 69 12.3 % O 20 39 128 12 1 1 201 35.8 % total 60 85 371 40 3 3 562 100.0 % wat (months - regstraton) Austra Belgum Germany Netherlands Slovena non ET total % 0-5 42 53 221 20 1 3 340 60.5 % 6-11 12 27 75 13 2 0 129 23.0 % 12-23 4 4 63 4 0 0 75 13.3 % 24-59 2 1 11 3 0 0 17 3.0 % 60+ 0 0 1 0 0 0 1 0.2 % total 60 85 371 40 3 3 562 100.0 % sequence Austra Belgum Germany Netherlands Slovena non ET total % frst 60 81 366 39 3 3 552 98.2 % repeat 0 4 5 1 0 0 10 1.8 % total 60 85 371 40 3 3 562 100.0 % 36

Table 4.10 Heart + lung transplants 2003 - characterstcs Cadaverc donor heart + lung transplants type of transplant Austra Belgum Germany Netherlands Slovena non ET total % heart only 60 85 371 40 3 3 562 94.8 % kdney + heart 2 2 3 0 0 0 7 1.2 % heart + both lungs 1 1 18 1 0 0 21 3.5 % heart + kdney + both lungs 0 0 1 0 0 0 1 0.2 % heart + whole lver + both lungs 0 0 1 0 0 0 1 0.2 % heart + whole lver 0 1 0 0 0 0 1 0.2 % total 63 89 394 41 3 3 593 100.0 % Heart + lung only transplant blood group Austra Belgum Germany Netherlands total % A 1 0 8 0 9 42.9 % AB 0 0 1 0 1 4.8 % B 0 1 0 0 1 4.8 % O 0 0 9 1 10 47.6 % total 1 1 18 1 21 100.0 % wat (months - regstraton) Austra Belgum Germany Netherlands total % 0-5 0 0 9 1 10 47.6 % 6-11 0 1 4 0 5 23.8 % 24-59 0 0 2 0 2 9.5 % 60+ 1 0 3 0 4 19.0 % total 1 1 18 1 21 100.0 % sequence Austra Belgum Germany Netherlands total % frst 1 1 18 1 21 100.0 % total 1 1 18 1 21 100.0 % 600 500 400 300 200 100 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Lung watng lst 90 141 203 227 224 204 216 224 350 377 430 462 517 Heart+Lung watng lst 48 48 49 71 79 71 66 60 46 42 43 43 45 Heart+Lung transplants 24 32 28 43 42 34 43 20 28 20 21 24 21 Lung transplants 71 109 119 138 125 154 155 228 239 258 272 358 385 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 2003 37

Table 4.11 Lung transplants 2003 - characterstcs Cadaverc donor lung transplants type of transplant Austra Belgum Germany Netherlands non ET total % Sngle lung 16 28 46 7 0 97 24.0 % Both lungs 71 40 143* 26 1 281 69.4 % Both lungs + whole lver 0 0 3 1 0 4 1.0 % both lungs + heart 1 1 18 1 0 21 5.2 % kdney + heart + both lungs 0 0 1 0 0 1 0.2 % heart + both lungs + whole lver 0 0 1 0 0 1 0.2 % total 88 69 212 35 1 405 100.0 % * 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 40 32 80 19 1 172 45.5 % AB 10 7 13 0 0 30 7.9 % B 9 1 21 3 0 34 9.0 % O 28 28 75 11 0 142 37.6 % total 87 68 189 33 1 378 100.0 % wat (months - regstraton) Austra Belgum Germany Netherlands non ET total % 0-5 73 35 70 12 0 190 50.3 % 6-11 12 19 41 8 1 81 21.4 % 12-23 1 13 40 6 0 60 15.9 % 24-59 1 1 37 7 0 46 12.2 % 60 + 0 0 1 0 0 1 0.3 % total 87 68 189 33 1 378 100.0 % sequence Austra Belgum Germany Netherlands non ET total % frst 79 66 180 32 1 358 94.7 % repeat 8 2 9 1 0 20 5.3 % total 87 68 189 33 1 378 100.0 % 38

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 196 258 1163 8 258 29 1912 not lver donors 33 16 204 1 110 2 366 cadaverc lver donors 163 242 959 7 148 27 1546 donor country Austra Belgum Germany Luxembourg Netherlands Slovena total whole lver procedure 156 230 919 6 141 26 1478 splt lver procedure 7 12 40 1 7 1 68 total 163 242 959 7 148 27 1546 donor country Austra Belgum Germany Luxembourg Netherlands Slovena total reported 156 230 919 6 141 26 1478 not procured 22 26 161 0 36 6 251 procured 132 204 754 6 105 20 1221 not transplanted 6 9 93 0 4 0 112 transplanted 126 195 661 6 101 20 1109 Splt lvers donor country Austra Belgum Germany Luxembourg Netherlands Slovena total potental splt lvers 14 24 80 2 14 2 136 splt lver not used 0 3 2 0 1 0 6 splt lver transplanted 14 21 78 2 13 2 130 Table 5.2 Actve cadaverc lver transplant watng lst as per December 31, 2003 - characterstcs type of transplant Austra Belgum Germany Netherlands Slovena total % lver 128 171 1218 119 8 1644 95.9 % lver + kdney 4 12 41 3 0 60 3.5 % lver + kdney + pancreas 0 1 1 0 0 2 0.1 % lver + lung 0 0 3 1 0 4 0.2 % lver + pancreas 1 0 3 0 0 4 0.2 % total 133 184 1266 123 8 1714 100.0 % 39

Table 5.3 Actve cadaverc lver only transplant watng lst as per December 31, 2003 - characterstcs blood group sequence tme watng (regstraton months) not not year A AB B O reported frst repeat 0-5 6-11 12-23 24 + reported 2003 721 59 233 631 0 1555 89 728 532 313 66 0 % 43.9% 3.6% 14.2% 38.4% 0.0% 94.6% 5.4% 44.3% 32.4% 19.0% 4.0% 0.0% 2002 566 38 194 498 0 1219 77 717 367 179 25 8 % 43.7% 2.9% 15.0% 38.4% 0.0% 94.1% 5.9% 55.3% 28.3% 13.8% 1.9% 0.6% 2001 461 36 171 374 0 986 56 613 321 97 9 2 % 44.2% 3.5% 16.4% 35.9% 0.0% 94.6% 5.4% 58.8% 30.8% 9.3% 0.9% 0.2% 2000 322 30 122 291 0 728 37 545 163 43 12 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 2003 - characterstcs Cadaverc donor lver transplants type of transplant Austra Belgum Germany Netherlands Slovena non ET total % splt lver 7 22 94 6 0 0 129 10.2 % whole lver 128 201 651 91 9 6 1086 85.9 % kdney + splt lver 0 1 7 0 0 0 8 0.6 % kdney + whole lver 5 9 16 2 0 0 32 2.5 % both lungs + whole lver 0 0 3 1 0 0 4 0.3 % pancreas + whole lver 1 1 0 0 0 0 2 0.2 % heart + both lungs + whole lver 0 0 1 0 0 0 1 0.1 % heart + whole lver 0 1 0 0 0 0 1 0.1 % kdney + pancreas + whole lver 0 0 1 0 0 0 1 0.1 % total 141 235 773 100 9 6 1264 100.0 % Lver only (cadaverc donor) transplant blood group Austra Belgum Germany Netherlands Slovena non ET total % A 56 93 337 38 6 4 534 44.0 % AB 7 9 48 8 0 2 74 6.1 % B 22 27 108 11 0 0 168 13.8 % O 50 94 252 40 3 0 439 36.1 % total 135 223 745 97 9 6 1215 100.0 % wat (regstraton months) Austra Belgum Germany Netherlands Slovena non ET total % 0-5 89 142 328 42 8 6 615 50.6 % 6-11 33 64 211 23 1 0 332 27.3 % 12-23 12 14 175 25 0 0 226 18.6 % 24-59 1 3 30 7 0 0 41 3.4 % 60 + 0 0 1 0 0 0 1 0.1 % total 135 223 745 97 9 6 1215 100.0 % sequence Austra Belgum Germany Netherlands Slovena non ET total % frst 121 193 653 82 8 6 1063 87.5 % repeat 14 30 92 15 1 0 152 12.5 % total 135 223 745 97 9 6 1215 100.0 % Table 5.5 Lvng donor lver transplants - lver only 2003 Lver only Austra Belgum Germany Netherlands total % domno 0 4 8 1 13 9.8 % non related 1 5 20 0 26 19.5 % related 5 35 54 0 94 70.7 % total 6 44 82 1 133 100.0 % 40

Table 5.5 Lvng donor lver transplants - lver only 2003 (contnued) related Austra Belgum Germany Netherlands total % brother / sster 0 5 4 0 9 9.6 % father 1 6 9 0 16 17.0 % grand father / mother 1 1 1 0 3 3.2 % mother 3 8 17 0 28 29.8 % nephew / nece 0 0 5 0 5 5.3 % son / daughter 0 15 16 0 31 33.0 % uncle / aunt 0 0 2 0 2 2.1 % total 5 35 54 0 94 100.0 % non related Austra Belgum Germany Netherlands total % other 1 2 1 0 4 100.0 % spouse 0 3 19 0 22 100.0 % total 1 5 20 0 26 100.0 % 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. 1800 1600 1400 1200 1000 800 600 400 200 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Lver watng lst 229 253 203 212 263 327 374 492 593 803 1093 1366 1714 Lvng donor transplants* 5 15 14 24 25 22 41 38 64 116 124 129 133 Cadaverc donor transplants 710 765 878 892 944 1032 1097 1071 1132 1168 1112 1136 1259 Fgure 5.1. Dynamcs of the Eurotransplant lver watng lst and lver transplants between 1991 and 2003 * ncludng domno transplants 41

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 196 258 1163 8 258 29 1912 not pancreas donors 127 62 611 1 159 6 966 cadaverc pancreas donors 69 196 552 7 99 23 946 Pancreas donor country Austra Belgum Germany Luxembourg Netherlands Slovena total reported 69 196 552 7 99 23 946 not procured 26 49 238 52 8 373 procured 43 147 314 7 47 15 573 not transplanted 10 54 116 4 17 6 207 transplanted 33 93 198 3 30 9 366 Table 6.2 Actve cadaverc pancreas transplant watng lst as per December 31, 2003 - characterstcs type of transplant Austra Belgum Germany Netherlands total % kdney+lver+pancreas 0 1 1 0 2 0.8 % kdney+pancreas 26 24 116 10 176 68.5 % lver+pancreas 1 0 3 0 4 1.6 % pancreas 15 31 25 4 75 29.2 % total 42 56 145 14 257 100.0 % Table 6.3a Actve cadaverc pancreas only transplant watng lst as per December 31, 2003 - characterstcs blood group sequence tme watng (regstraton months) not year A AB B O reported frst repeat 0-5 6-11 12-23 24 + 2003 30 1 4 40 0 49 25 19 18 18 10 % 40.0% 1.3% 5.3% 53.3% 0.0% 65.3% 33.3% 25.3% 24.0% 24.0% 13.3% 2002 26 1 3 34 0 46 18 32 9 9 14 % 40.6% 1.6% 4.7% 53.1% 0.0% 71.9% 28.1% 50.0% 14.1% 14.1% 21.9% 2001 26 1 6 37 0 41 29 20 7 15 28 % 37.1% 1.4% 8.6% 52.9% 0.0% 58.6% 41.4% 28.6% 10.0% 21.4% 40.0% 2000 34 1 9 43 0 48 39 17 13 20 37 % 39.1% 1.1% 10.3% 49.4% 0.0% 55.2% 44.8% 19.5% 14.9% 23.0% 42.5% 42

Table 6.3b Actve cadaverc kdney+pancreas transplant watng lst as per December 31, 2003 - characterstcs blood group sequence tme watng (regstraton months) not year A AB B O reported frst repeat 0-5 6-11 12-23 24 + 2003 56 4 22 94 0 166 10 77 50 45 4 % 31.8% 2.3% 12.5% 53.4% 0.0% 94.3% 5.7% 43.8% 28.4% 25.6% 2.3% 2002 83 3 16 117 0 208 11 96 86 29 8 % 37.9% 1.4% 7.3% 53.4% 0.0% 95.0% 5.0% 43.8% 39.3% 13.2% 3.7% 2001 43 7 12 82 0 137 7 77 36 28 3 % 29.9% 4.9% 8.3% 56.9% 0.0% 95.1% 4.9% 53.5% 25.0% 19.4% 2.1% 2000 65 3 15 112 0 183 12 81 76 34 4 % 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 2003 - characterstcs Cadaverc donor pancreas transplants type of transplant Austra Belgum Germany Netherlands total % Pancreas 3 11 21 1 36 11.2 % Islets 4 24 4 0 32 10.0 % Kdney + pancreas 33 29 169 16 247 76.9 % Kdney + slets 0 0 3 0 3 0.9 % Kdney + lver + pancreas 0 0 1 0 1 0.3 % Pancreas + lver 1 1 0 0 2 0.6 % total 41 65 198 17 321 100.0 % Pancreas only (cadaverc donor) transplant blood group Austra Belgum Germany Netherlands total % A 1 7 11 1 20 55.6 % AB 1 0 1 0 2 5.6 % B 0 0 2 0 2 5.6 % O 1 4 7 0 12 33.3 % total 3 11 21 1 36 100.0 % wat (regstraton months) Austra Belgum Germany Netherlands total % 0-5 2 10 9 0 21 58.3 % 6-11 0 1 8 0 9 25.0 % 12-23 0 0 4 1 5 13.9 % 24-59 1 0 0 0 1 2.8 % total 3 11 21 1 36 100.0 % sequence Austra Belgum Germany Netherlands total % frst 1 7 6 0 14 38.9 % repeat 2 4 15 1 22 61.1 % total 3 11 21 1 36 100.0 % Table 6.4b Number of pancreas slet transplantatons 2003 AIBTP BBCTP BLATP GGITP total recpents transplanted 2 13 2 6 23 number of transplants 4 22 2 7 35 number of donors used 5 79 2 7 93 43

Table 6.4c Pancreas transplants 2003 - characterstcs Cadaverc donor pancreas transplants type of transplant Austra Belgum Germany Netherlands total % Pancreas 3 11 21 1 36 11.2 % Islets 4 24 4 0 32 10.0 % Kdney + pancreas 33 29 169 16 247 76.9 % Kdney + slets 0 0 3 0 3 0.9 % Kdney + lver + pancreas 0 0 1 0 1 0.3 % Pancreas + lver 1 1 0 0 2 0.6 % total 41 65 198 17 321 100.0 % Pancreas + kdney only (cadaverc donor) transplants blood group Austra Belgum Germany Netherlands total % A 15 8 84 6 113 45.7 % AB 1 1 10 0 12 4.9 % B 4 4 13 1 22 8.9 % O 13 16 62 9 100 40.5 % total 33 29 169 16 247 100.0 % wat (regstraton months) Austra Belgum Germany Netherlands total % 0-5 20 12 29 0 61 24.7 % 6-11 9 9 72 2 92 37.2 % 12-23 3 7 62 11 83 33.6 % 24-59 1 1 5 3 10 4.0 % 60+ 0 0 1 0 1 0.4 % total 33 29 169 16 247 100.0 % sequence Austra Belgum Germany Netherlands total % frst 33 28 163 16 240 97.2 % repeat 0 1 6 0 7 2.8 % total 33 29 169 16 247 100.0 % 350 300 250 200 150 100 50 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Islet+Kdney & Pancreas+Kdney 120 141 112 98 85 110 127 155 193 195 226 289 257 watng lst Pancreas+Kdney transplants 70 62 92 87 98 131 189 230 282 308 311 213 250* Islets+Kdney transplant 0 0 0 1 5 9 13 4 4 3 0 5 3 Pancreas transplants 4 4 2 3 1 8 15 17 13 27 37 39 36 Islet transplants 0 1 6 5 15 6 9 7 2 0 3 46 32 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

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. 7.2.1 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 16 3.9 HLA-DR 2 0.5 * 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. 7.2.2 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

Table 7.2: Report of molecular typng results MHC Locus Typngs (N) 2d* 4d* Class I HLA-A 250 232 HLA-B 238 241 Class II HLA-DRB1 165 363 HLA-DQB1 38 240 * = 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 3 1 1 HLA-A,B 3 3 2 HLA-DRB1 1 8 2 HLA-DQB1 0 3 0 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. 7.2.3 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. 7.2.4 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 2003-2004 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

of Eurotransplant. Informaton for partcpaton can be obtaned from the ETRL or the Eurotransplant Admnstraton. A comparson between the perod 2002-2003 and 2003-2004 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 50 80 45 40 35 30 2002 2003 70 60 50 N 25 40 20 15 10 5 30 20 10 0 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 01.01.2004 47

P8. Publcatons n 2003 8.1 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): 204-8 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): 113-7 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 15 2003; 75 (3): 418-20 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 27 2003; 75 (6): 884-889 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): 90-96 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: 12-21 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: 22-41 Claas FHJ, Roelen DL, Oudshoorn M, Doxads IIN Future HLA matchng strateges n clncal transplantaton In: Dev Ophthalmol 2003; 36: 62-73 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): 163-170 48

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: 600-606 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: 552-556 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): 1159-62 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): 1185-9 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); 1400-6 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): 1492-7 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: 6599-6603. 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): 1604-8 49

A9. Abbrevated Fnancal Statements Balance sheet Assets 31.12.2003 31.12.2002 x 1000 x 1000 Fxed assets 911 790 Short term recevables 1.361 2.116 Lqud assets 2.654 1.844 4.926 4.750 Labltes 31.12.2003 31.12.2002 x 1000 x 1000 Equty 235 235 Reserve funds 2.974 2.766 Short term labltes 1.717 1.748 4.926 4.750 Statement of ncome and charges Income 2003 2002 x 1000 x 1000 Regstraton fees 4.115 3.835 Procurement fees 2.360 2.014 Mscellaneous 95 95 6.570 5.944 Charges 2003 2002 x 1000 x 1000 Salares 2.574 2.351 Procurement charges 2.185 2.014 General expenses 738 812 Medcal expenses 62 60 Transport 42 44 Housng 181 170 Deprecaton 312 315 Mscellaneous 267 191 6.362 5.956 Explotaton balance 208-12 Appropraton of Results Addton Reserve Fund explantaton costs 175 0 Addton Tarff Equalty Reserve 33-12 208-12 50

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, 2004. 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 174.555. The reserve funds per December 31, 2003 are posetvely effected by 1.869.262. Ths alteraton has no effect on the explotaton balance 2002. The reserve funds per December 31, 2002 are posetvely effected by 1.694.707. Audtor's report We have audted the abbrevated fnancal statements of Stchtng Eurotransplant Internatonal Foundaton, at Leden, for the year ended December 31, 2003. These abbrevated fnancal statements have been derved from the fnancal statements of Stchtng Eurotransplant Internatonal Foundaton for the year ended December 31, 2003. 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, 2004. Leden, May 3, 2004 Delotte Accountants 51