Organ sharing principles kidney-pancreas or pancreas alone
Donor Organ
Sharing Scheme
Operating Principles
for
Pancreas Transplant Units
in the UK
First published: August 2003
UK Transplant
Organ Sharing Scheme Operating Principles
for Pancreas Transplant Units in the UK
| Change No. | Advisory Group Ref: | Date of Change | Details of Change |
|---|---|---|---|
UK Transplant
Organ Sharing Scheme Operating Principles
for Pancreas Transplant Units in the UK
A-1 Background
A-2 Overview of the scheme
Figure 1 Pancreas
allocation scheme (flow chart)
C Pancreas Balance of Exchange
C-1 Calculation
method
C-2 Pancreas matching run (PMR)
Index
Annex A: Direction of the Secretary of State for Health: 1st October 2005 - The NHS Blood and Transplant (Gwaed a Thrawsblaniadau’r GIG) (England) Directions 2005 (133Kb) - Guidance
Annex B: Cadaveric Donor Assurances and Damage Reporting, Updated December 2002 (84Kb) - 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
1.1 A national allocation scheme for kidney/pancreas and pancreas alone (Pancreas Allocation Scheme) was introduced in the UK on 27 August 2003 to provide a formal, open basis on which to exchange pancreata for transplantation to benefit potential recipients.
1.2 The scheme was agreed by the
UKT Kidney and Pancreas Advisory Group and was ratified by
Transplant Unit Directors at the Renal Transplant Services
meeting. The basis for allocation is detailed below.
Contents...
2.1 Figure 1 gives an overview of the new national Pancreas Allocation Scheme and how it fits in with kidney allocation. Pancreata used for islets are excluded.
Click here to access Figure 1.
2.2 The Pancreas Allocation Scheme 'matching run' is independent of the one for the Kidney Allocation Scheme. The UK Transplant Duty Office will use the two lists to co-ordinate the offering process. Kidney/pancreas patients take priority over all kidney only patients with one exception - 000 mismatched paediatric patients. When a kidney/pancreas block or pancreas alone becomes available, it is used at the pancreas retrieval centre wherever possible. A kidney/pancreas block may be retained by the retrieving centre for either a simultaneous pancreas and kidney transplant (SPK) or for pancreas transplant alone (PTA). In this case the pancreas balance of exchange (PBoE) just counts one retained organ.
If the organ(s) cannot be used locally because
a) there are no suitable recipients or
b) because the kidney/pancreas block or pancreas alone is from a hospital with no associated pancreas
retrieval unit,
the block/pancreas alone is offered for use elsewhere.
2.3 In the case where the pancreas cannot be used by the retrieving centre, the pancreas balance of exchange will identify the order in which centres should be offered the organ(s). Once again, if a kidney/pancreas block is offered, it can be used for either SPK or PTA for the centre's choice of patient. In the case of a tie on balance, distance between the donating hospital and the pancreas will be the deciding factor in order to minimise cold ischaemia time.
2.4 If the pancreas is used by one of the centres, the pancreas balance of exchange will be recalculated (subtract one from receiving centre, add one to the exporting centre). The kidney balance of exchange will also be updated.
2.5 If no centre accepts the pancreas for transplant
as either SPK or PTA, the retrieval centre can then use the
pancreas for islets (transplant or research). If the centre
does not wish to retain the pancreas for such use, it should
be offered on to other islet centres. Pancreata not used for
whole organ transplants (ie used for islet transplants) fall
outside of this Pancreas Allocation Scheme.
Contents...
B. PANCREAS TRANSPLANT CENTRES
1.1 The pancreas transplant centres in the UK included in this scheme are shown below with their corresponding pancreas retrieval areas:
| Pancreas transplant unit | Area for pancreas retrieval |
|---|---|
| Cambridge, Addenbrooke's Hospital | As per Cambridge kidney retrieval area |
| Liverpool, Royal Liverpool University Hospital | As per Liverpool kidney retrieval area |
| Manchester, Royal Infirmary | As per Leeds and Manchester kidney retrieval areas |
| London, St Mary's Hospital | As per North Thames Alliance kidney retrieval area |
| Newcastle, Freeman Hospital | As per Newcastle kidney retrieval area |
| Oxford, Churchill Hospital | As per South, West and Wales Alliance kidney retrieval area |
| London, Guy's Hospital | As per South Thames Alliance kidney retrieval area |
| Edinburgh, Royal Infirmary | As per Scotland Alliance kidney retrieval area |
1.2 Pancreas units will take responsibility for retrieval of pancreata identified for donation in their associated geographical area (ie retrieve themselves or liaise with relevant liver retrieval team).
1.3 There is no pancreas unit to cover the areas defined by the kidney retrieval areas relating to Belfast, Birmingham, Coventry and the Trent Alliance centres (Nottingham, Sheffield, Leicester). Retrieval of pancreata identified in these areas will be the responsibility of the centre accepting the pancreas for transplant (according to the balance of exchange order of offering). Once again, they will retrieve or liaise with the relevant liver retrieval team.
1.4 Patients requiring pancreas or kidney/pancreas
transplants will be registered at one of the centres identified
above. Only these centres will have a pancreas balance of
exchange (PBoE). However, if a patient is to be considered
for a kidney only transplant at a centre not listed above,
the patient must be registered at the kidney centre on the
national waiting list and not registered with UKT for the
kidney/pancreas. This will ensure that the patient does not
miss out on the offer of a kidney only. New registration arrangements
will avoid this complication in the future.
Contents...
C. PANCREAS BALANCE OF EXCHANGE
1.1 Since 27 August 2003, the number
of pancreata retained, exported and imported by each of the
centres listed above together with their centre balance of
exchange (exports-imports) are calculated and stored in a
similar way to the current kidney balance of exchange. Exports
from centres other than those listed will count as exports
to 'non-pancreas centres'. Only pancreata resulting in a transplant
will be included. Adult and paediatric donors and recipients
will all be counted on the one PBoE. The counting of pancreata
will not depend on whether or not a kidney accompanied the
pancreas. The working of the kidney balance of exchange should
not be affected in any way by the Pancreas Allocation Scheme.
Contents...
C.2 PANCREAS MATCHING RUN (PMR)
2.1 The donor information to be displayed at the head of a PMR (common with kidney matching run) are as follows:
- Donor id
- Donor name
- Blood group
- Age
- Weight
- Hepatitis C
- CMV
- HLA-DR homozygosity
- Tissue type
- Donor hospital
2.2 A matching run may be initiated before the donor
tissue type is available. Allocation is not dependent on HLA
match between donor and recipient although patient sensitisation
is clearly a consideration.
2.3 Centre order
The pancreas unit associated with the donor hospital is listed
first and remaining centres will then be listed according
to their PBoE (high to low). For donor hospitals without an
associated pancreas retrieval unit, all centres will be listed
according to PBoE. Each centre's PBoE will be listed alongside
the centre name.
2.4 Any Group 2 patients will only be eligible after
all Group 1 kidney/pancreas patients and all Group 1 kidney
only patients (for offers involving a kidney).
Contents...
| Index | Paragraph Number |
| Background | A.1 |
| Pancreas Allocation Scheme | Figure 1 |
| Overview of the scheme | A.2 |
| Pancreas Balance of Exchange | |
| Calculation method | C.1 |
| Pancreas matching run (PMR) | C.2 |
| Pancreas transplant centres | B |
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