Allocation to pediatric recipients around the world: An IPTA global survey of current pediatric solid organ transplantation deceased donation allocation practices

Abstract

Background There has not been a comprehensive global survey of pediatric‐deceased donor allocation practices across all organs since the advent of deceased donor transplantation at the end of the 20th century. As an international community that is responsible for transplanting children, we set out to survey the existing landscape of allocation. We aimed to summarize current practices and provide a snapshot overview of deceased donor allocation practices to children across the world. Methods The International Registry in Organ Donation and Transplantation (IRODAT, http://www.irodat.org) was utilized to generate a list of all countries in the world, divided by continent, that performed transplantation. We reviewed the published literature, published allocation policy, individual website references and associated links to publicly available listed allocation policies. Following this, we utilized tools of communication, relationships, and international fellowship to confirm deceased donation pediatric centers and survey pediatric allocation practices for liver, kidney, heart, and lung across the world. We summarize pediatric allocation practices by organ when available using source documents, and personal communication when no source documents were available. Results The majority of countries had either formal or informal policies directed toward minimizing organ distribution disparity among pediatric patients. Conclusion Children have long‐term life to gain from organ donation yet continue to die while awaiting transplantation. We summarize global strategies that have been employed to provide meaningful and sustained benefit to children on the waitlist.

Worldwide organ allocation systems for pediatric lung transplantation

“…We will first focus on the previous LAS policy and historical specifics around pediatric LTX. In the US, LAS was first implemented in 2005, and had only been applied to patients ≥12 years of age, with younger patients prioritized based on a two‐tier system (assigned Priority 1 or 2, then ranked based on wait time) 12 . Subsequently, there was a change in geographic allocation up to a 250 nautical mile radius, rather than locally.…”

“…In the US, LAS was first implemented in 2005, and had only been applied to patients ≥12 years of age, with younger patients prioritized based on a two-tier system (assigned Priority 1 or 2, then ranked based on wait time). 12 Subsequently, there was a change in geographic allocation up to a 250 nautical mile radius, rather than locally. The lung CAS framework is expected to offer more fair and flexible organ distribution, rather than the LAS which offered a set of classifications.…”

“…Pediatric lung allocation systems around the world were surveyed. This is based on work that was completed by the International Pediatric Transplant Association (IPTA) 12 . The International Registry in Organ Donation (IRODAT) was first utilized to determine the countries that are currently performing deceased donor transplantation in pediatrics.…”

HLA (emphasis on DQ) compatibility for longer allograft survival in pediatric transplantation: Modern evidence and challenges

“…Implementation of HLA matching criteria might be difficult without impacting waiting time, especially in countries with relatively low donor numbers. Given that pediatric patients suffer from increased waiting time more than their adult counterparts, most programs attempt to give absolute/relative priority to pediatric candidates over adults, although the exact degree to which children are prioritized varies, resulting in only a few countries that truly emphasize HLA matching criteria to allocate organs from deceased donors 18 . The most prominent approach is that of the Eurotransplant model, 19 intelligently attempting to balance between these two factors.…”

Embracing Complexity to Better Serve Pediatric Kidney Transplant Recipients

“…Internationally, pediatric allocation priority is heterogeneously structured but clinically simplistic. 5 Donor age is commonly used as the primary mechanism to identify organs for prioritized pediatric sequences. Many systems, including EuroTransplant, Brazil, and South Africa, prioritize pediatric donor organs (younger than 18 years) for pediatric recipients, although thresholds for prioritization range from donor age younger than 16 (India) to younger than 50 years (Scandinavia).…”