Donor Organ
Sharing Scheme
Operating
Principles for
Renal Transplant Units
in the UK
First Published: May 1999
UK Transplant
Organ Sharing Scheme Operating Principles
for Renal Transplant Units in the UK
Changes to Donor Organ Sharing Scheme - Operating Principles
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CHANGE No.
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ADVISORY GROUP REF:
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DATE OF CHANGE
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DETAILS OF CHANGE
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1
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KAG(M)(99)1
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March 1999
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A-3 Paediatric Cases Paragraphs 3.3, 3.4 and 3.5 |
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A-6 Offering Time Paragraph 6.2 |
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2
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KAG(M)(99)2
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October 1999
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A-3 Paediatric Cases Paragraph 3.6 |
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3
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RUM-01-00
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Jan 2000
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B-2 Allocation Priority - Adult Donor Kidneys |
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C-2 Allocation Priority - Paediatric Donor Kidneys |
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4
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RUM-01-00
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Jan 2000
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B-2 Allocation Priority Adult Donor Kidneys |
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5
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RUM-01-00
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Jan 2000
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E-2 Balance of Exchange |
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6
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RTSM-01-01
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Jan 2001
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A-5 Contraindications Paragraphs 5.1 and 5.3. |
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D-1 Points scoring mechanism |
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E-2 Balance of Exchange |
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7
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KPAG(M)(01)2
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Nov 2001
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A-3 Paediatric Cases Paragraph 3.4 |
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A-10 Non-Heartbeating Donors |
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C-2 Allocation Priority - Paediatric Donor Kidneys |
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8
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RTSM-02-02
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Feb 2002
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B-2 Allocation Priority - Adult Donor Kidneys |
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Paragraph 2.2.4 amended |
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Paragraphs 2.2.2 and 2.2.3 re-numbered |
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9
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RTSM-02-02
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July 2002
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A General - Included - deletion of identical blood group matched patients |
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B. - Adult Donor Kidneys |
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C. - Paediatric Donor Kidneys Sections updated to allow ABO-O donor kidneys to some ABO-B recipients |
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A.4 Donor information, paragraph 4.2 - clarified |
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A.9 Single donor kidney - clarified |
UK
Transplant
Organ Sharing Scheme Operating Principles
for Renal Transplant Units in the UK
A-1
Registration of New Recipients
A-2
Group 1 & Group 2
Recipients
A-3
Paediatric Cases
A-4
Donor Information
A-5
Contraindications
A-6
Offering Time
A-7
Definition of a Favourable
Match
A-8
Kidneys Deemed to be Unusable
A-9
Single Kidney Donor
A-10
Non-Heartbeating Donors
A-11
Highly Sensitised
Patients
B-1
Donor Definition
B-2
Allocation Priority - Adult Donor
Kidneys
B-3
Tie Breaks - Adult Recipients
B-4
Tie Breaks - Paediatric
Recipients
C-1
Donor Definition
C-2
Allocation Priority - Paediatric
Donor Kidneys
C-3
Tie Breaks - Paediatric
Recipients
C-4
Tie Breaks - Adult
Recipients
E-1
Calculation method
E-2
Local Sharing Arrangements
E-3
Combined Kidney & Pancreas
Transplant
E-4
Combined Kidney & Multiple Organ
Transplant
F Kidneys Offered by the Republic of Ireland
Annex A:Direction of the Secretary of State for Health: 12 February 1996 - Directions on the Allocation of Human Organs for Transplantation - Guidance. (pdf files):
Annex B (MS Word document) : Cadaveric Donor Assurances and Damage Reporting, Updated December 2002 - Protocol prepared by the British Transplantation Society, the UK Transplant Co-ordinators' Association and UK Transplant.
UK
Transplant
Donor Organ Sharing Scheme Operating Principles
Renal Transplant Units in the UK
The Donor Organ Sharing Scheme principles set out below are those specified by Renal Transplant Unit Directors in the UK. The Scheme is administered on the transplant community's behalf through UK Transplant (UKT).
Included
- Group 1 kidney patients on the active Transplant Waiting List
Excluded
- patients with unacceptable antigens which are present in the donor HLA type;
- patients who do not achieve their minimum match grade;
- patients from the Republic of Ireland;
- patients awaiting multiple organ transplants.
A.1 REGISTRATION OF NEW RECIPIENTS
1.1All patients awaiting a transplant must be registered on the National Transplant Database at UKT.
1.2A standard registration form must be
completed and sent to UKT via the UKNTN (UK National
Transplant Network) or by post. Patients will be
placed on the National Transplant Database waiting
list on the day on which details are received at UKT.
Discrepancies or missing information will be followed
up with the local unit and might cause a delay.
Contents...
A.2 GROUP 1 & GROUP 2 RECIPIENTS
2.1Recipients are categorised as Group 1 or Group 2 (as defined by Direction of the Secretary of State for Health: 12 February 1996 - Directions on the Allocation of Human Organs for Transplantation - Guidance, copy at Annex A). Nationals of a non-UK country may only be registered on a transplant waiting list after they have been accepted by a consultant as suitable for treatment. It is the responsibility of the consultant registering such a patient on the waiting list to confirm that they have been accepted under E112 or similar arrangements.
2.2Group 1 patients have priority above Group 2 patients. Group 2 patients registered in the UK will be offered kidneys before offers are made to the Republic of Ireland, European Organ Exchange Organisations or Group 2 Countries abroad. No kidney should be offered to a Group 2 patient if there is a clinically suitable Group 1 patient.
The allocation protocol is as follows:
2.2.1To Group 1 patients at: Renal Transplant
Units in the UK;
2.2.2To Group 2 patients at: Renal Transplant
Units in the UK;
2.2.3To Group 1 patients at: the Renal
Transplant Unit in the Republic of Ireland;
2.2.4To Group 2 patients at: the Renal
Transplant Unit in the Republic of Ireland.
Thereafter, UKT will offer any organs which remain surplus to Organ Exchange Organisations in Europe and elsewhere as follows:
1 Organ Exchange Organisations in EC and other Group 1 countries;
2 Organ Exchange Organisations in Group 2 countries.
3.1Paediatric recipients, defined as patients
aged under 18 years at the time of offer, will
receive priority within the offering sequence for
kidneys available from paediatric and adult donors.
For the purpose of these Operating Principles, a
paediatric donor is defined as a patient aged under
18 years at the time of death.
3.2A unit may register a small adult, weighing
35 kg or less, as paediatric at their discretion.
3.3Unless otherwise agreed by the transplant
unit, only kidneys from donors aged 50 years or under
will be offered to paediatric patients. Some units
may have a lower age criteria which must be met.
3.4Usually paediatric donor organs will be
offered first to paediatric recipients, then to adult
recipients before being offered to European Organ
Exchange Organisations. However, patients awaiting a
combined multi-organ transplant including a kidney
will be given priority for one kidney from paediatric
donors. No paediatric kidney should be offered to a
Group 2 patient if there is a clinically suitable
Group 1 patient.
3.5Favourably matched blood group B paediatric
patients will be eligible for blood group O and B
donor kidneys. Favourably matched blood group AB
paediatric patients will be eligible for blood group
A, B and AB donor kidneys.
3.6Kidneys from donors under 5 years of age
should be retrieved only for use en bloc for adult
recipients.
Contents...
4.1All potential kidney donors in the UK must be reported prospectively by telephone to the UKT Duty Office at the earliest possible opportunity.
4.2Full donor information including HLA-A, B, and DR typing information must be given to determine the priority list of suitable patients on the National Transplant Waiting List.
4.3The Core Donor Information Form and Kidney
Donor Information Form contain the information
required for all kidney donors.
Contents...
A.5
CONTRAINDICATIONS
5.1Potential kidney donors who are untested for either Hepatitis B surface antigen, or Hepatitis C and HIV antibody, or found to be positive for HIV antibody are an absolute contraindication to organ donation and will not be offered by donor units or UKT. Kidneys from donors who are found to be positive for Hepatitis B or Hepatitis C can be used in patients who are already immune (HBsAg antibody) or infected (Hepatitis C antibody and/or PCR positive) in a life-saving situation.
5.2Where a donor is found to fall into any of the risk categories defined by the Chief Medical Officer as contraindications to donation for organ transplantation, UKT will actively seek, record and pass on alldonor information for the transplant unit to make the decision on the suitability of the donor organs.
5.3Fuller information regarding cadaveric
donor assurances and damage reporting are contained
in the protocol prepared by the British
Transplantation Society, the UK Transplant
Co-ordinators' Association and the UK Transplant -
'Cadaveric Donor Assurances and Damage Reporting,
updated April 2002' (copy at
Annex B). Definitive guidance is contained in
the document prepared by the Advisory Committee on
Microbiological Safety of Blood and Tissue for
Transplantation (MSBT) - 'Guidance on the
Microbiological Safety of Human Organs, Tissues and
Cells Used in Transplantation, August 2000'.
Contents...
6.1Offers will be made in accordance with the kidney recipient matching run listed in the priority match order. For all cases, centres must advise UKT within 30 minutes whether they wish to accept or decline the offer.
6.2If a kidney is not firmly allocated to a
matched patient 20 hours after retrieval, it will be
offered back to the donating centre, and if not
accepted, to the centre holding the kidney for use in
any suitable patient.
Contents...
A.7 DEFINITION OF A FAVOURABLE MATCH
7.1A favourable match is defined as no more than one mis-match for HLA-A and/or HLA-B and no mis-matches for HLA-DR in terms of the following specificities, (1996 nomenclature).
A locus: 1, 2, 3, 9, 10, 11,
28, 29, 19 (excluding 29), 36, 43, 80;
B locus: 5, 7, 8, 12, 13, 14, 15, 16, 17, 18,
21, 22, 27, 35, 37, 40, 41, 42, 46, 47, 48, 53, 59,
67, 70, 73, 78, 81, 82, 83;
DR locus: 1, 103, 2, 3, 4, 5, 6, 7, 8, 9, 10,
11(5), 12(5).
Contents...
A.8 KIDNEYS DEEMED AS UNUSABLE
8.1Kidneys which are rejected for the same clinical reasons by five separate recipient centres will be deemed unusable. Such kidneys will be offered by the UKT Duty Office by telephone to those units which have requested to be offered such kidneys.
8.2Kidneys offered through this scheme will be listed in the priority order detailed in the adult and paediatric sections over.
8.3Kidneys transplanted through this scheme
will be included on the appropriate Balance of
Exchange.
Contents...
9.1Where a donor has only one kidney suitable
for transplant, it should be offered through the
national scheme at Tier 1 for 000 mis-matched
patients. If not allocated to a Tier 1 patient, the
kidney may be retained for local use in any patient.
Contents...
10.1Units are not obliged to offer kidneys
from non-heartbeating donors. When offered, kidneys
from non-heartbeating donors will be offered in
accordance with the kidney matching run. Both
transplanted imports and exports will count in
Balance of Exchange.
Contents...
A.11 HIGHLY SENSITISED PATIENTS
11.1Highly Sensitised Patients (HSP) are determined as having a defined reaction frequency against a random panel > = 85%.
11.2Highly Sensitised Patients will be given
priority within Tier 1 in the national scheme such
that blood group compatible kidneys will be allocated
to 000 mis-matched Highly Sensitised Patients.
Contents...
1.1An adult kidney donor is defined as being
aged 18 years or over at the time of death.
Contents...
B.2 ALLOCATION PRIORITY - ADULT DONOR KIDNEYS
All adult kidneys donated in the UK will be offered through UKT for comparison with the HLA type of patients on the active National Transplant Database waiting list for blood group identical patients and blood group compatible 000 mis-matched HSP patients or 000 mis-matched or favourably matched paediatric patients. With effect from 1 July 2000 HLA-DR homozygous patients have precedence for HLA-DR homozygous donor organs and from 1 July 2002, blood group B (ABO-B) patients are given access to blood group O donor kidneys (ABO-O). In all tiers, priority will be given to paediatric patients. The National Transplant Database will be used to sort and allocate kidneys as follows:
2.1 000 Mis-matches - Paediatric Patients
| Local Paediatric HSP DR homozygous | compatible and identical blood groups | Within each group, sort in order of waiting time |
| National Paediatric HSP DR homozygous | ||
| Local Paediatric HSP DR heterozygous | ||
| National Paediatric HSP DR heterozygous | ||
| Local Paediatric non-HSP DR homozygous | identical and permitted compatible blood groups | |
| National Paediatric non-HSP DR homozygous | ||
| Local Paediatric non-HSP DR heterozygous | ||
| National Paediatric non-HSP DR heterozygous |
| Local Adult HSP DR homozygous |
compatible and identical
blood groups
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Within each group, sort in order of Points score (high to low) |
| National Adult HSP DR homozygous | ||
| Local Adult HSP DR heterozygous | ||
| National Adult HSP DR heterozygous | ||
| Local Adult non-HSP DR homozygous |
ABO-O to O
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| National Adult non-HSP DR homozygous | ||
| Local Adult non-HSP DR homozygous |
ABO-O to B
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| National Adult non-HSP DR homozygous | ||
| Local Adult non-HSP DR heterozygous |
ABO-O to O
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| National Adult non-HSP DR heterozygous | ||
| Local Adult non-HSP DR heterozygous |
ABO-O to B
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| National Adult non-HSP DR heterozygous |
Kidneys will be matched to blood group identical patients except where indicated in the above table. DR homozygous patients are given priority only when the donor is homozygous.
2.2 Tier 2: Favourable Matches (100, 010, 110)
Remaining favourably
matched kidneys (100, 010, 110 mis-matches in
HLA-A, B, DR order) may be allocated through the
national pool. In this Tier, patients will be
sorted using the following priority order:
| Local Paediatric DR homozygous | identical and permitted compatible blood groups | Within each group, sort in order of waiting time (high to low) |
| National Paediatric DR homozygous | ||
| Local Paediatric DR heterozygous | ||
| National Paediatric DR heterozygous |
| Local Adult DR homozygous |
ABO-O to O
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Within each group, sort in order of Points score (high to low) |
| National Adult DR homozygous | ||
| Local Adult DR homozygous |
ABO-O to B
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| National Adult DR homozygous | ||
| Local Adult DR heterozygous |
ABO-O to O
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| National Adult DR heterozygous | ||
| Local Adult DR heterozygous |
ABO-O to B
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| National Adult DR heterozygous |
2.3In Tier 1, both kidneys will be allocated nationally where no local 000 mis-matched patients at the same or higher priority level are identified. If one kidney has been allocated to any patient (local or national) within Tier 1 and no remaining patients exist in Tier 1, and there are no favourably matched paediatric patients in Tier 2, then the second kidney may be retained for local use in any patient.
2.4If there are no national 000 mis-matched patients or favourably matched paediatric patients, but there are both local and national adult favourably matched patients then one kidney must be allocated to a favourably matched patient (locally or nationally) in accordance with the nationally agreed priority order. The second kidney may be retained for local use in any patient.
2.5With effect from 1 July 2000, priority for the second kidney from an adult donor will be given to local and national favourably matched paediatric patients above local adult favourably matched patients.
2.6 Non Favourable Matches - Adult Patients
Where no 000 mis-matches or favourable matches are found nationally or locally, the donated kidneys may be retained for local use. A local unit, which is unable to use a non-favourably matched kidney, will offer it through UKT: allocation will be to the unit which, at the time, has the highest positive centre Balance of Exchange (adult Balance of Exchange for adult donors; paediatric Balance of Exchange for paediatric donors), i.e:
| National Paediatric | Sort centres by Paediatric Balance of Exchange |
| National Adult | Sort centres by Adult Balance of Exchange |
2.7In the context of this Scheme, local refers
to a single unit or an alliance where such exists.
Contents...
B.3 TIE BREAKS - ADULT RECIPIENTS
3.1Tier 1 & 2
3.1.1Where more than two equally matched patients are identified for any one kidney in either Tier 1 or Tier 2, a points scoring mechanism will be used to determine the choice (see Section D).
3.1.2In the event of a tie in points score at Tier 1 or Tier 2, the recipient at the centre closest to the offering/retrieval centre, based on transport time, will receive the offer.
3.2Tier 3
3.2.1Where there is a tie of equally matched patients with an identical centre Balance of Exchange at Tier 3, the recipient at the closest centre to the offering/retrieval centre, based on transport time, will receive the offer.
3.3If two or more patients are equally well
matched, have the same points score and are at the
same centre, then that centre will select which of
those patients to transplant.
Contents...
B.4 TIE BREAKS - PAEDIATRIC RECIPIENTS
4.1Tier 1 & 2
4.1.1Where more than two equally matched patients are identified for any one kidney in either Tier 1 or Tier 2, waiting time (i.e. the longer) will be used to determine the choice.
4.1.2In the event of a tie of patients with equal waiting time at Tier 1 or Tier 2, the recipient at the closest centre to the offering/retrieval centre, based on transport time, will receive the offer.
4.2Tier 3
4.2.1Where there is a tie of equally matched patients with an identical centre Balance of Exchange at Tier 3, the tie break used will be the waiting time (i.e. the longer) in the case of paediatric recipients.
4.3If two or more patients are equally well
matched, have the same waiting time and are at the
same centre, then that centre will select which of
those patients to transplant.
Contents...
1.1A paediatric donor for kidneys is defined
as being aged under 18 years at the time of death.
Contents...
C.2 ALLOCATION PRIORITY - PAEDIATRIC DONOR KIDNEYS
All donated paediatric kidneys will be offered through UKT for comparison with the HLA type of patients on the active National Transplant Database waiting list for blood group identical patients and blood group compatible 000 mis-matched HSP patients or 000 mis-matched or favourably matched paediatric patients. With effect from 1 July 2000 HLA-DR homozygous patients have precedence over HLA-DR homozygous donor organs and from 1 July 2002, blood group B (ABO-B) patients are given access to blood group O donor kidneys (ABO-O). All paediatric kidneys will be offered first for paediatric patients and then for adult patients using the adult kidney allocation scheme (Section B-2 sets out the adult scheme). The National Transplant Database will be used to sort and allocate kidneys as follows:
2.1 000 Mis-matches - Paediatric Recipients
| Local Paediatric HSP DR homozygous | compatible and identical blood groups | Within each group, sort in order of waiting time |
| National Paediatric HSP DR homozygous | ||
| Local Paediatric HSP DR heterozygous | ||
| National Paediatric HSP DR heterozygous | ||
| Local Paediatric non-HSP DR homozygous | identical and permitted compatible blood groups | |
| National Paediatric non-HSP DR homozygous | ||
| Local Paediatric non-HSP DR heterozygous | ||
| National Paediatric non-HSP DR heterozygous |
2.2 Favourable Matches, (100, 010, 110 mis-matches) - Paediatric Patients
| Local Paediatric DR homozygous | identical and permitted compatible blood groups | Within each group, sort in order of waiting time (high to low) |
| National Paediatric DR homozygous | ||
| Local Paediatric DR heterozygous | ||
| National Paediatric DR heterozygous |
2.3 Non Favourable Matches - Paediatric Recipients
| Local Paediatric | Sort centres by Paediatric Balance of Exchange (high to low) |
| National Paediatric |
2.4 000 Mis-matches - Adult Patients
| Local Adult HSP DR homozygous |
compatible and identical
blood groups
|
Within each group, sort in order of Points score (high to low) |
| National Adult HSP DR homozygous | ||
| Local Adult HSP DR heterozygous | ||
| National Adult HSP DR heterozygous | ||
| Local Adult non-HSP DR homozygous |
ABO-O to O
|
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| National Adult non-HSP DR homozygous | ||
| Local Adult non-HSP DR homozygous |
ABO-O to B
|
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| National Adult non-HSP DR homozygous | ||
| Local Adult non-HSP DR heterozygous |
ABO-O to O
|
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| National Adult non-HSP DR heterozygous | ||
| Local Adult non-HSP DR heterozygous |
ABO-O to B
|
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| National Adult non-HSP DR heterozygous |
2.5 Other Favourable Match, (100, 010, 110 mis-matches) - Adult Patients
| Local Adult DR homozygous |
ABO-O to O
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Within each group, sort in order of Points score (high to low) |
| National Adult DR homozygous | ||
| Local Adult DR homozygous |
ABO-O to B
|
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| National Adult DR homozygous | ||
| Local Adult DR heterozygous |
ABO-O to O
|
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| National Adult DR heterozygous | ||
| Local Adult DR heterozygous |
ABO-O to B
|
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| National Adult DR heterozygous |
2.6 Non Favourable Matches - Adult Patients
| Local Adult | Sort centres by Adult Balance of Exchange (high to low) |
| National Adult |
2.7 Multi-Organ Transplants
Patients awaiting a
combined multi-organ transplant including a kidney
will be given priority for one kidney from a
paediatric donor.
Contents...
C.3 TIE BREAKS - PAEDIATRIC RECIPIENTS
3.1000 Mis-match and Favourable Match
3.1.1Where there is a tie of equally matched patients, waiting time (i.e. the longer) will be used to determine the choice. In the event of a tie in waiting time, the recipient at the closest unit to the offering/retrieval centre, based on transport time, will receive the offer.
3.2Non Favourable Match
3.2.1Where there is a tie of paediatric
Balance of Exchange, the transport time between the
offering/retrieval centre and the recipient centre(s)
will be used to determine the choice.
Contents...
C.4 TIE BREAKS - ADULT RECIPIENTS
4.1For tie break situations follow the rules
set out in section B.3.
Contents...
D.1The following mechanism will be used to determine the choice between equally matched adult patients at Tier 1 or Tier 2.
| 1.1 | Recipient Age | old to young | 1 - 10 points | favours younger recipient |
| Donor/Recipient Age Difference | large to small | 1 - 10 points | avoids large age difference | |
| Waiting Time | short to long | 0.5 to 5 points | favours longest waiting | |
| Matchability | easy to hard | 1 - 10 points | favours rarer HLA types | |
| Sensitisation | high to low | 0.5 to 3 points | favours low sensitisation
avoids +ve cross matches |
|
| Balance of Exchance | low to high | 1 - 10 points | favours higher centre balance | |
| Total between | 5 - 48 points |
Contents...
1.1UKT will maintain records of the Balance of Exchange for each centre which will:
include all kidneys which are transplanted;
report kidneys retained and used locally as well as those which are exchanged;
separate out adult and paediatric donor kidneys;
count every transplanted kidney as one import and one export;
count as one import and one export a pair of kidneys used as a pair (en bloc) for one patient.
Contents...
E.2 LOCAL SHARING ARRANGEMENTS
2.1Kidneys derived from Wexham Park Hospital (shared by North Thames and Oxford) will be dealt with as follows:
000 matched kidneys
2.2Where two 000 matches are found elsewhere in the UK (not at either of the sharing retrieval centres), both of the pair of kidneys will be donated to the national pool and exported. Both parties to the shared scheme will receive one credit point in the Balance of Exchange.
2.3Where one 000 kidney is identified elsewhere in the UK, one of the pair will be exported through the national scheme. One of the pair will be retained locally and it will be a local decision as to which unit is to retain the one remaining kidney, and which will count the export credit.
Favourably matched kidneys
2.4Where favourably matched recipients are identified elsewhere in the UK, the retrieving unit will be advised but there will be no obligation on either unit to export one or both kidneys through the National Sharing Scheme. If one or both units decide to give up their right to the kidney for a favourable match elsewhere in the country, the same credit and decision arrangements will apply as for 000 kidneys.
2.5Where both kidneys are retained, both units
will be credited with the use of one kidney.
Contents...
E.3 COMBINED KIDNEY AND PANCREAS TRANSPLANTS
3.1For a local combined kidney and pancreas
transplant, the kidney will be counted as the locally
retained kidney. The other kidney will be allocated
through the National Sharing Scheme for 000 and
favourably mis-matched recipients.
Contents...
E.4 COMBINED KIDNEY AND MULTIPLE ORGAN TRANSPLANTS
4.1A kidney used for a multiple organ
transplant (kidney plus heart, lungs or liver) will
be counted as being allocated through the National
Sharing Scheme. The other of the pair may be retained
locally if there are no other national 000 mis-match
patients. Multiple organ transplant recipients will
not appear on a kidney matching run.
Contents...
F. KIDNEYS OFFERED BY THE REPUBLIC OF IRELAND
1.From time to time the Republic of Ireland offers kidneys surplus to their requirements to transplant units in the UK through the UKT Duty Office. In such cases the kidney(s) will be offered using the procedure set out in Sections B.2, .3 and .4 for adult donors and Sections C.2, .3 and .4 for paediatric donors.
2.Any surplus kidneys which are offered from
the Republic of Ireland but declared 'unusable' on
referral, will be offered using the procedure set out
in Section A.8.
Contents...
|
Paragraph Number
|
|
| Allocation - Adult Donor Kidneys | |
| Allocation - Paedriatric Donor Kidneys | |
| Balance of Exchange |
|
|
|
|
|
|
|
|
|
| Contraindications | |
| Donor Definition - Adult | |
| Donor Definition - Paediatric | |
| Donor Information | |
| Favourable Match | |
| Group 1 & Group 2 Recipients | |
| Highly Sensitised Patients (HSP) | |
| Kidney & Pancreas Transplants | |
| Kidneys offered by the Republic of Ireland | |
| Local Sharing Arrangements | |
| Multiple Organ Transplants | |
| Non-Heartbeating Donors | |
| Offering Time | |
| Paediatric Cases | |
| Points Scoring Mechanism | |
| Registration of New Recipients | |
| Single Kidney Donor | |
| Tie Breaks - Adult | |
| Tie Breaks - Paediatric | |
| Unusable kidneys |