Johannesburg Region Allocation of Deceased Donor Kidneys 2011.

Controversies Meeting 7-8 May 2011

Prof R.S.Britz and Nephrology Panel

Kim Crymble Transplant Coordinator.

In the beginning..prior to 2004Kidneys were allocated in a 50 / 50 split between

the state and the private sector to patients on the waiting lists.

The allocation was on Hla matches and negative cross match.

High PRA’s viewed as a reason not to allocate an organ even with a negative cross match a decision made by SANBS not the attending Nephrologists.

Regional Demographics In Johannesburg we have 3 Health Care

Providers where Renal Transplant are performedCMJAH as the State Sector facility who provides

Renal Transplantation for all State listed Patients Johannesburg and surrounding areas but also from Klerksdorp and Polokwane.

Netcare ( Milpark and Garden City Clinic) and Wits Donald Gordon Medical Centre who provide Transplant Care for the Privately funded Patients.

Health for all and access to CareIt was always viewed that the State Sector

Patient should always have equal access to Health Care as Organs Donated are from the community and should be for the benefit to all within the community.

So despite where donors are identified and harvested we had an allocation of one kidney to state and one kidney to the private list.

Private Vs Public Sector Harvested donors Johannesburg Region.

5 6

24

6

25

11

18

24

28

17

21

30

0

5

10

15

20

25

30

35

2004 2005 2006 2007 2008 2009 2010

Public

Private

Total Number of Donors Johannesburg 2010: 35 Donors

16

24

26

32

25

23

26

35

0

5

10

15

20

25

30

35

40

2004 2005 2006 2007 2008 2009 2009 2010

The current Allocation. The Allocation has evolved in the last few

years.

Based on an evaluation of all the currently used allocation systems worldwide and adapted for our Region.

Any decision related to the current system has been debated and accepted by all members of the Academic Renal Panel in Johannesburg.

Deceased Donor Kidney Allocation

The allocation system is Point based

Mostly a Time based system

Excel spread sheet run after defining system

Scrapped 50:50 system in 2010

Now everyone on one allocation list State and Private

Kidneys allocated to individuals not centres

State organ still largely sponsored by private

How does the Point System work. 1 year = 1 pointMinimal (No) HLA weighting2nd and subsequent transplants

penalized by 3 pointsPaeds get preference (extra points)Only 6 high PRA patients X matched

at any timeTop 30 patients cross matched

Age matched kidney allocationNon-Expanded criteria Kidneys Kidneys from Donors under the age of 55.

Expanded Criteria Kidneys (ECK)

Kidneys from Donors over the age of 55 or 2 of the following if the death has been due to a CVA, history of Hypertension Serum Creat levels are over 150.

Allocated to > 40 yr old recipients only>55 yr old patients only eligible for ECK

Minimum Donor Data required for allocation of Kidneys. Non Expanded Criteria Donor Age

Expanded Criteria DonorAge / Date of BirthSerum CreatMedical History

Recipient DataIndependent Data capturerEnters data and administers the listFor all Kidney Transplant recipients in

Johannesburg

Information required:JHB Renal Panel formPatients HLA and current PRA’sPhysician assessment form which claims

fitness for Transplant.

Allocation Spreadsheet:Donor ID :  

 

       GROUP O

 EXPANDED CRITERIA DONOR KIDNEY?

N

MUST SORT THIS

COLUMN ASCENDING!    

Date:

09/05/2011 KIDNEY

         

LISTING ORDER

X Match +Ve?

PT NO. .Name PRA Urgent? HospPoints              

1 Y 71 KHES**, SIP** 85  

JHB PAEDS 10

ADDITIONAL URGENT PATIENT

           

2 N 73 KH**, X** 83   CHB 10

 

NAMEPT NO. PRA

X Match +Ve?

Urgent?

B Group Patient?

3  Y 49 GEL***, T**

100   KLERK 9

  Nil Nil Nil Nil Y  

4  N 46 F**, H** 98   WITS 8

Allocated 1st, UNLESS there is an urgent listed in top 10

     

Thank You

Queries to Professor R.S.Britz

011 356 6488.