Germany's Federal Medical Council has published new criteria for the allocation of organs to patients who have transplants after the passage of a recent law that specified that organs should be allocated to individuals rather than to transplant centres, as had occurred in the past.
The new guidelines try to give equal chances to each patient while taking into account the urgency and prospective outcome of transplantation. For each organ a system has been developed that distributes a number of points to the individual patient on the waiting list, according to strict criteria.
For instance, for kidneys, points are given according to HLA matching (40%), how long the patient has been waiting (30%), mismatch probability (10%) and how long the kidney would have to be conserved before it could be transplanted (20%). Children receive bonus points.
Apart from blood group and size, hearts and livers are mainly distributed according to how long a patient has waited and the conservation time of the donor organ. Patients with high urgency status have preference. However, the status decision has to be based on certain criteria and is audited by an expert committee, which is not involved in the particular transplantation. Violators of the new rules will be punished.
The new guidelines will be operated by Eurotransplant in Leiden, the Netherlands, which will receive the official contract as allocation centre for Germany in the next months. However, Eurotransplant still has to adjust its current guidelines according to the new rules and find a way of harmonising them with the allocation in its other member countries.
Eurotransplant has been allocating organs for Germany in the past 30 years as well as for the Netherlands, Belgium, Luxembourg, and Austria, and recently for Slovenia.
The new guidelines not only regulate the allocation of organs but also specify which patients can become candidates for transplants. If a patient is rejected the reasons have to be recorded and patients have to be informed about their place on the waiting list. The guidelines specify which patients will not be accepted for transplantation. Among those patients excluded are: alcoholic patients who have not been abstinent for the past six months, HIV infected patients, heavy smokers, drug addicts, and patients with severe cardiovascular disease.