Liver Organ Sharing Principles
Donor Organ
Sharing Scheme
Operating Principles
for
Liver Transplant Units
in the UK and Republic of Ireland
First Published: July 1999
UK Transplant
Organ Sharing Scheme Operating Principles
for Liver Transplant Units in the UK and Republic of Ireland
| Change No. | Advisory Group Ref: | Date of Change | Details of Change |
|---|---|---|---|
| 1 | LAG(M)(98)1 | April 1998 | A.3 Paediatric Cases Paragraph 3.4 |
| 2 | LAG(M)(98)2 | November 1998 | F.2 Fast Track Scheme Paragraph 2.3 |
| 3 | LAG(M)(99)2 | November 1999 | B.1 Super Urgent Diagnosis Paragraph 1.1 C.2 and c.3 Adult Allocation Priority Paragraphs 2.2 and 3.1 D.2 and D.3 Paediatric Allocation Priority Paragraph 2.1 and 3.1 E-1 Balance of Exchange Paragraphs 1.1.1 and 1.1.6 |
| 4 | LAG(M)(00)1 | May 2000 | A.6 Offering Time Paragraph 6.4 A.7 Use of Blood Group O Livers Paragraph 7.4 F.1 and F.2 Fast Track Offer Scheme |
| 5 | O3.4.1/07.00 | July 2000 | D.2 Allocation Priority Paediatric Donor Liver and Composite Liver and Small Intestine D.3 Allocation Priority Paediatric Donor Isolated Small Intestine |
| LAG(M)(00)2 | November 2000 | A.5 Contraindications Paragraph 5.5 B.5 Super Urgent Scheme, Exceptions Paragraph 5.5 F.2 Fast Track Offer Scheme Paragraph 2.3 |
|
| 6 | LAG(M)(02)1 | May 2002 | A.8 Domino Livers A.9 Non-heartbeating donor livers E.1 Balance of Exchange Calculation |
| 7 | LAG(M)(02)2 | October 2002 | A.7 Use of Blood Group 'O' Livers, Paragraph 7.5 B.1 Super Urgent Diagnosis, Paragraphs 1.1(1), 1.2 B.4 Super Urgent Allocation, addition of para 4..2 |
| 8 | LAG(M)(04)2 | November 2004 | A.9 Allocation of non-heartbeating donor livers F.2 Operating the Fast Track Scheme, Paragraph 2.2 C.2 Allocation priority: Adult, Addition of section 2.4 D.2 Allocation priority: Paediatric, Addition of section 2.3 |
| 9 | August 2005 | B.1 Super Urgent Diagnosis, Paragraph 1.1 | |
| October 2005 | B.1 Super Urgent Diagnosis, Paragraph 1.1 | ||
| 10 | LAG(M)(05)2 | November 2005 | B.5 Exceptions, Paragraph 5.3 F.1 Fast Track Offer Scheme, Addition of para 1.3 C.2 Allocation priority, Addition of paragraph 2.2.2 |
| 11 | LAG(M)(06)1 | April 2006 | A.7 Use of Blood Group ‘O’ Livers, Paragraph 7.1 C.4 and E Liver Allocation Sequence A.6 Offering time, addition of paragraph 6.3 |
| 12 | LAG(M)(06)2 | November 2006 | A.7 Use of Blood Group ‘O’ Livers, Paragraph 7.1 |
| 13 | LAG(M)(07)1 | May 2007 | A.10 Liver Splitting. Addition of section C.2 Allocation priority (adult) Addition of priority for hepatoblastoma patients, 2.2.3 D.2 Allocation priority (paediatric) Addition of priority for hepatoblastoma patients, 2.1.3 |
| 14 | LAG(M)(07)2 | November 2007 | A.6 Offering Time 6.7 |
UK Transplant
Donor Organ Sharing Scheme for Liver Transplant Units in the
UK and Republic of Ireland
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 Use of Blood Group O Livers
A-8 Domino Livers
A-9 Non-heartbeating Donor Livers
A-10 Liver Splitting
B-1 Super Urgent Diagnosis
B-2 Scheme Registration
B-3 Peer Review
B-4 Super Urgent Liver Scheme Ranking
B-5 Exceptions
C-1 Donor Definition
C-2 Allocation - Adult Donor Organs Liver and
Composite Liver and Small Intestine
C-3 Allocation - Adult Donor Organs - Small
Intestine
C-4 The Liver Centre Rota
D-1 Donor Definition
D-2 Allocation - Paediatric Donor Organs - Liver
and Composite Liver and Small Intestine
D-3 Allocation - Paediatric Donor Organs - Small
Intestine
D-4 The Liver Allocation Sequence
E-1 Calculation
F-1 Offers from the UK
F-2 Operating the UK Scheme
F-3 Offers from Europe
F-4 Operating the European Scheme
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
Liver Transplant Units in the UK and Republic of Ireland
The Donor Organ Sharing Scheme principles set out below are those specified by Liver Transplant Unit Directors in the UK and Republic of Ireland. The Scheme is administered on the transplant community's behalf through UK Transplant (UKT).
A.1 REGISTRATION OF NEW RECIPIENTS
1.1 All patients awaiting a transplant must be registered on the National Transplant Database at UKT.
1.2 A 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.
1.3 In an emergency, as defined in Section B-2, a Super Urgent recipient registration can be made by telephone and a temporary form will be completed at UKT. Centres must ensure that a replacement form is completed and sent to UKT at the first opportunity following the telephoned registration.
1.4 UKT will maintain a waiting list of patients requiring small intestine and composite liver and small intestine grafts.
1.4.1 For recipients awaiting small intestine grafts, paediatrics will be given priority; offering criteria will be defined by size, age and geography.
1.4.2 For recipients awaiting composite
liver and small intestine grafts, offering will be in line
with the liver allocation sequence. Priority will be given
to paediatrics; offers for paediatric patients will be made
following offers to Super Urgent Liver Scheme recipients.
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A.2 GROUP 1 & GROUP 2 RECIPIENTS
2.1 Recipients are categorised as Group 1 or Group 2 (as defined by The NHS Blood and Transplant (Gwaed a Thrawsbkniadau’r GIG) (England). Directions 2005 - Guidance, copy at Annex A). It should nevertheless be noted that 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.
2.2 Group 1 patients have priority
for available organs above Group 2 patients. Group 2 patients
registered in the UK and Republic of Ireland will be offered
liver or liver and small intestine before offers are made
to European Organ Exchange Organisations or Group 2 countries
abroad. No organ should be offered to a Group 2 patient in
the UK or Republic of Ireland if there is a clinically suitable
Group 1 patient in the UK or Republic of Ireland.
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3.1 Paediatric recipients, defined as patients aged 16 years or under at the time of offer, will receive priority within the offering sequence for non Super Urgent recipients for any paediatric donor. For the purposes of these Operating Principles, a paediatric donor is defined as a patient either aged under 16 years, or a body weight of under 35 kilos at the time of death.
3.2 A unit may register a small adult, weighing 45Kg or less, as paediatric at their discretion.
3.3 Paediatric donor organs will be offered first to paediatric recipients, then to adult recipients before being offered to European Organ Exchange Organisations. No paediatric organ should be offered to a Group 2 patient in the UK or Republic of Ireland if there is a clinically suitable Group 1 patient in the UK or Republic of Ireland.
3.4 Organs from older paediatric
donors aged over 12 years may be used for adult recipients
of small intestine/liver composite grafts and adult recipients
of multi organ heart/lung/liver grafts.
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4.1 All potential liver donors in the UK or Republic of Ireland must be reported by telephone to the UKT Duty Office as soon as either:
i the brain stem death tests have been confirmed; or
ii relatives' consent has been obtained; or
iii Coroner's consent has been obtained.
4.2 The Core Donor Data Form and
Liver Donor Information Form contain the information required
for all liver donors and must be used when reporting the case
to UKT.
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5.1 Potential donors found to be positive for HIV antibody are an absolute contraindication to organ donation.
5.2 Neither donor units nor UKT will offer livers from donors who have not been tested for Hepatitis B surface antigen, Hepatitis C antibody or HIV antibody.
5.3 Livers from donors found to be positive for Hepatitis B surface antigen, Hepatits B core AB, or for Hepatitis C antibody will be offered by UKT to transplant units for use in life-saving situations. The final decision whether or not to accept the organ lies with the transplant surgeon..
5.4 Where 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 all donor information for the transplant unit to make the decision on the suitability of the donor organ.
5.5 Fuller 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 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...
6.1 Offers will be made in accordance with the Liver Centre Rota, on the basis of a firm offer to the first centre and a provisional offer to the second in line.
6.2 For all cases, centres with a firm offer must advise UKT within 60 minutes whether they wish to accept or decline the offer. If the organ is declined, it will be offered to the second in line as a firm offer and to the third in line as a provisional offer, and so on through the liver allocation sequence.
6.3 Centres must declare within the 60 minutes offering time if they wish to accept a kidney to accompany a liver. Beyond the 60 minutes, kidneys will only be allocated by the kidney allocation scheme and the pancreas allocation scheme.
6.4 For first offers made to a centre previously advised provisionally, UKT must be advised within 45 minutes whether they wish to accept or decline.
6.5 Only once all centres have declined for Group 1 patients, will Group 2 patient requirements be considered. However, the UKT Duty Office will routinely ask each centre which refuses a liver for a Group 1 patient to state whether they would wish to accept for a Group 2 patient.
6.6 A centre to which an offer has been made will retain its place on the liver allocation sequence while a decision is pending, although the UKT Duty Office will use discretion in offering a second time to centres which are currently considering an offer. A centre declining an offer will retain its place on the liver allocation sequence.
6.7 Should there be simultaneous zonal donor referrals which could delay retrieval, the next liver team on the allocation sequence should be contacted to ascertain if alternative arrangements can be made. In these instances, the team agreeing to retrieve may choose an elective patient of their own to transplant.
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A.7 USE OF BLOOD GROUP 'O' LIVERS
7.1 Blood group O donor livers should be offered in the following priority order:
1 blood group O patients locally*
2 blood group O patients nationally** - note 'B' blood group patients can be considered for liver left lateral segments
3 blood group A, B or AB patients locally
4 blood group A, B or AB patients nationally
7.2 Non-compliance will be followed up by UKT.
7.3 Super Urgent recipients take priority in all blood groups.
7.4 These rules will be waived for fast track liver offers.
7.5 These rules will be waived
for children under two years of age who require a liver transplant.
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8.1 The transplantation of domino
livers is a developmental procedure and is therefore outside
of the formal liver allocation process. Retrieving units may
preferentially use domino livers. Priority should be given
to Group 1 patients over Group 2 patients. Livers from domino
donors are excluded from the Balance of Exchange calculation.
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A.9 NON-HEARTBEATING DONOR LIVERS
9.1 The use of livers from non-heartbeating donors is currently outside of the formal liver allocation process. Livers from non-heartbeating donors will be allocated as follows:
- the centre that retrieves a liver from a non-heartbeating donor will have priority in using that liver. Group 1 patients should take priority over Group 2 patients; the local centre may accept a liver for a Group 2 patient before offering nationally for a Group 1 patient.
- if not required locally, or should a centre not have a local agreement to share livers from non-heartbeating donors, the liver will be offered through the fast track scheme to those centres that have registered their willingness to consider offers of livers from non-heartbeating donors; the acceptance of such offers for Group 1 patients will take precedence over acceptance for Group 2 patients;
10.1 Heart-beating donors who are less than 40 years of age, weigh more than 50 kilograms and have stayed in ITU for less than 5 days meet the basic liver splitting criteria. Should the retrieval team wish to consider splitting the liver and offer a left lateral segment, the segment will be allocated as follows:
- left lateral segments offered to UK paediatric liver centres in accordance with the liver allocation sequence
- should the retrieval team be a paediatric centre then their paediatric patients have primacy over patients at the other paediatric centres
- left lateral segments from 'O' blood group donors must be offered for 'O' and 'B' blood group paediatrics nationally before consideration is given to other blood group paediatrics
- should the left lateral segments be declined by the paediatric centres then the retrieval centre can transplant the liver as a whole liver
- any lobes (right lobe/left lobe) will be offered to all UK centres in accordance with the liver allocation sequence.
1.1 The Super Urgent Liver Scheme is available to Group 1 patients only in the UK and Republic of Ireland. To be registered on the Super Urgent Liver Scheme at least one of the following criteria must be met:
1 - Category 1: Aetiology: Paracetamol poisoning: pH <7.25 more than 24 hours after overdose and after fluid resuscitation
2 - Category 2: Aetiology: Paracetamol poisoning: Co-existing prothombin time >100 seconds or INR >6.5, and serum creatinine >300 μmol/l or anuria, and grade 3-4 encephalopathy
3 - Category 3: Aetiology: Paracetamol poisoning: Serum lactate more than 24 hours after overdose >3.5 mmol/l on admission or >3.0 mmol/l after fluid resuscitation
4 - Category 4: Aetiology: Paracetamol poisoning: Two of the three criteria from category 2 with clinical evidence of deterioration (eg increased ICP, FiO2 >50%, increasing inotrope requirements) in the absence of clinical sepsis
5 - Category 5: Aetiology: Seronegative hepatitis, hepatitis A, hepatitis B, or an idiosyncratic drug reaction. Prothrombin time >100 seconds or INR >6.5, and any grade of encephalopathy
6 - Category 6: Aetiology: Seronegative hepatitis, hepatitis A or hepatitis B or an idiosyncratic drug reaction. Any grade of encephalopathy, and any three from the following: unfavourable aetiology (idiosyncratic drug reaction, seronegative hepatitis), age >40 years, jaundice to encephalopathy time >7 days, serum bilirubin >300μmol/l, prothrombin time >50 seconds or INR >3.5
7 - Category 7: Aetiology: Acute presentation of Wilson’s disease, or Budd-Chiari syndrome. A combination of coagulopathy, and any grade of encephalopathy
8 - Category 8: Hepatic artery thrombosis on days 0 to 14 after liver transplantation
9 - Category 9: Early graft dysfunction on days 0 to 7 after liver transplantation with at least two of the following: AST >10,000, INR >3.0, serum lactate >3 mmol, absence of bile production
In addition, a further criterion is the total absence of liver function (eg after total hepatectomy).
1.2 Acute liver failure in children under two years of age:
1 Definition: Multisystem disorder in which severe acute impairment of liver function with or without encephalopathy occurs in association with hepatocellular necrosis in a child with no recognised underlying chronic liver disease.
2 INR > 4 or Grade 3/4 encephalopathy
3 Patients taking paracetamol overdose adult criteria apply, eg: pH < 7.3 (following appropriate resuscitation)
4 Exclude leukaemia/lymphoma, haemophagocytosis and disseminated intra-vascular coagulopathy
5 Other causes of acute liver failure not cured by liver transplantation include Mitochondrial disorders with neurological involvement, Niemann-Pick disease type C and Giant-cell hepatitis with Coombs' positive haemolytic anaemia
1.3 No other causes of liver
failure may be considered appropriate for registration on
the Super Urgent Liver Scheme.
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B.2 SUPER URGENT LIVER SCHEME REGISTRATION
2.1 Initial registration
on the Super Urgent Liver Scheme must be made by telephone
to the UKT Duty Office. UKT will place the recipient on the
Super Urgent Liver scheme and notify all liver transplant
centres in the UK and the European Organ Exchange Organisations
by telephone and facsimile. The recipient centre must immediately
complete a Super Urgent Registration Form which must be counter-signed
by the Clinician and sent to UKT by facsimile, by a UKNTN
connection or if necessary by urgent courier. On receipt,
UKT will facsimile an anonymised copy of the form to all designated
liver transplant centres.
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B.3 PEER REVIEW BY DIRECTORS OF DESIGNATED LIVER UNITS
3.1 Centres wishing to seek clarification of the details of a recipient on the Super Urgent Liver Scheme must notify UKT by facsimile. The Clinician from the centre seeking clarification will make direct contact with the registering unit and discuss the case clinician to clinician. In cases where clarification has been sought, UKT will seek confirmation of the patient's status from the registering unit 24 hours after a registration.
3.2 A summary of recipients
on the Super Urgent Liver Scheme will be sent by facsimile
to all designated centres by UKT each day. The summary will
show the date and time of registration on the Super Urgent
Liver Scheme.
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B.4 SUPER URGENT LIVER SCHEME RANKING
4.1 The sequence of offers for recipients registered as Super Urgent will be strictly in relation to blood group and the time of registration; the blood group compatible patient having been registered the longest at any one time taking priority, and thereafter in reverse-chronological order by time of registration. For this purpose, UKT will maintain a list of Super Urgent registrants.
4.2 Offers for paediatric patients under 2 years of age may be accepted for incompatible blood groups.
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5.1 Units which have a Super Urgent recipient registered, and subsequently identify a suitably matched blood group local donor, may retain the local donor for their Super Urgent recipient irrespective of other Super Urgents registered at the time. However, the Super Urgent recipient must already be registered with UKT.
5.2 If a unit has accepted an offered liver for a Super urgent recipient and subsequently identify a suitably matched blood group donor, they should either:
1 give up the right to the offered liver if the offered liver is not en route to them; or
2 retain the offered liver and the local liver if the offered liver has been received or is en route to them.
5.3 Disputes at 5.1 and 5.2 should be decided by mutual consent surgeon to surgeon. Until the Duty Office received further clarification, the patient will remain on the super-urgent list.
5.4 When a Super Urgent patient is registered at UKT after a liver has been offered to and accepted by a unit for a non Super Urgent patient but is not yet implanted, the non Super Urgent recipient shall retain priority for using the liver. However, the UKT Duty Office will advise the transplanting unit of the newly-registered Super Urgent recipient and it is for the transplanting unit Director to decide whether to retain the offer or to give it up. In such cases it will not be possible for UKT to organise peer review prior to advising the transplanting centre of the newly-registered Super Urgent case. If the patient does not receive the previously accepted liver, peer review will be carried out in the normal way.
5.5 When a liver has been
accepted for a Super Urgent patient and the transplant does
not proceed, for recipient reasons, the organ should first
be offered back to the zonal retrieval team. If not accepted
by the zonal team, the liver will be offered through the Fast
Track Offer Scheme.
Contents...
1.1 An adult donor for liver
is defined as being either a patient aged 16 years or over,
or with a body weight of 35 kilos or over at the time of death.
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C.2 ALLOCATION PRIORITY - ADULT DONOR LIVER AND COMPOSITE LIVER & SMALL INTESTINE
2.1 All livers donated in the Republic of Ireland will be used in that country for any patient on the waiting list, whether Super Urgent or elective. Livers from the Republic of Ireland which cannot be used in that country will be offered to Units in the UK through the UKT Duty Office.
2.2 All livers or composite livers and small intestines donated in the UK, and those livers declared surplus in the Republic of Ireland, will be offered by UKT in the following priority order for Group 1 recipients at:
2.2.1 any centre in the UK or Republic
of Ireland for Super Urgent recipients;
2.2.2 designated1 centres in the UK or Republic of Ireland for combined liver/small intestine graft adult recipients (where donor is between 16 and 45 years of age and weighs less than 60 kgs).
2.2.3 patients with hepatoblastoma
2.2.4 ‘Top Band’ patients (if applicable)
2.2.5 the designated zonal retrieval centre – see 2.4;
2.2.6 designated centres in the UK or Republic of Ireland – see 2.4;
2.2.7 non-designated centres in the UK or Republic of Ireland.
2.3 Offers will then be made to centres in the following priority order for Group 2 recipients at:
2.3.1 any centre in the UK or Republic
of Ireland for patients requiring an emergency re-transplant;
2.3.2 the designated zonal retrieval centre;
2.3.3 designated centres in the UK or Republic of Ireland;
2.3.4 non-designated centres in the UK or Republic
of Ireland.
Thereafter, UKT will offer any organs which remain surplus to Organ Exchange Organisations in Europe and elsewhere as follows:
2.4 Should a centre split a liver and wish for a lobe to be offered on, the lobe(s) should be offered as follows:1 Organ Exchange Organisations in EC and other Group 1 countries for emergency patients;
2 Organ Exchange Organisations in EC and other Group 1 countries;
3 Organ Exchange Organisations in Group 2 countries.
2.4.1 The left lateral segment will be offered to designated paediatric centres4 in accordance with the liver allocation sequence.
2.4.2 The lobe will be offered to all centres in accordance with the liver allocation sequence.
Contents...
4 The designated centres that are designated by NSCAG to carry out grafts in paediatric patients: (1) Birmingham Children’s Hospital, Birmingham in conjunction with Queen Elizabeth Hospital, Birmingham, (2) Kings College Hospital, London and (3) St James' University Hospital, Leeds.Back...
C.3 ALLOCATION PRIORITY - ADULT DONOR ISOLATED SMALL INTESTINE
3.1 All isolated small intestines donated in the UK and Republic of Ireland will be offered by UKT in the following priority order for Group 1 recipients at:
3.1.1 designated1 centres in the UK or Republic of Ireland for isolated small intestine graft.
3.2 Offers will then be made to centres in the following priority order for Group 2 recipients at:
3.2.1 designated1 centres in the UK or Republic of Ireland for isolated small intestine graft.
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.
4.1 Donor organ offers for non Super Urgent recipients will be in accordance with the liver allocation sequence. The sequence will comprise first designated centres, always headed by the zonal retrieval centre, and secondly, non-designated centres transplanting livers in the UK and Republic of Ireland.
4.1.1 The liver allocation sequence will be used to advise designated centres of the availability of a donor organ, regardless of whether a patient of the appropriate blood group is registered from their unit on the National Transplant Database at the time.
4.1.2 The liver allocation sequence will be sequenced according to each centre’s transplant activity, based on a rolling 4 week period (not including the most immediate week to allow for transplants to be recorded on the National Transplant Database). The centre with the least number of transplants during this period will appear top of the sequence, down to the centre with the most number of transplants.
4.1.3 Offers will be made to non-designated centres in accordance with the liver allocation sequence only when a suitable blood group recipient is registered from their unit on the National Transplant Database.
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1 The designated centres are those designated by NSCAG to carry out small intestine grafts in adult patients: St James's Hospital, Leeds and Addenbrooke's Hospital, Cambridge.Back...
1.1 A paediatric donor is defined
as being a patient either aged under 16 years or with a body
weight of under 35 kilos at the time of death.
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D.2 ALLOCATION PRIORITY - PAEDIATRIC DONOR LIVER AND COMPOSITE LIVER & SMALL INTESTINE
2.1 All paediatric donor livers or composite livers and small intestines donated in the UK, and those surplus in the Republic of Ireland, will be offered in the following priority order for Group 1 recipients at:
2.1.1 any centre in the UK or Republic
of Ireland for Super Urgent recipients;
2.1.2 the designated1 centre in the UK or Republic of Ireland for paediatrics in need of liver and small intestine (where donor is less than 16 years of age and weighs less than 35 kgs).;
2.1.3 patients with hepatoblastoma
2.1.4 the designated zonal retrieval centre for paediatric recipients – see 2.3;
2.1.5 designated centres in the UK or Republic of Ireland for paediatric recipients – see 2.3;
2.1.6 non-designated centres in the UK or Republic of Ireland for paediatric recipients;
2.1.7 'Top Band' patients (if applicable)
2.1.8 the designated zonal retrieval centre for adult recipients – see 2.3;
2.1.9 designated centres in the UK or Republic of Ireland for adult recipients – see 2.3;
2.1.10 non-designated centres in the UK or Republic of Ireland for adult recipients.
2.2 Offers will then be made to centres in the following priority order for Group 2 recipients at:
2.2.1 any centre in the UK or Republic
of Ireland for patients requiring an emergency re-transplant;
2.2.2 the designated zonal retrieval centre;
2.2.3 other designated centres in the UK or Republic
of Ireland;
2.2.4 non-designated centres in the UK or Republic
of Ireland.
1 The designated centre is that designated by NSCAG to carry out composite liver and small intestine grafts in paediatric patients: Birmingham Children's Hospital, Birmingham in conjunction with Queen Elizabeth Hospital, Birmingham.Back...
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 for emergency patients;
2 Organ Exchange Organisations in EC and other Group 1 countries;
3 Organ Exchange Organisations in Group 2 countries.
2.3 Should a centre split a liver and wish for a lobe to be offered on, the lobe(s) should be offered:
2.3.1 The left lateral segment will be offered to designated paediatric centres4 in accordance with the liver allocation sequence.
2.3.2 The right lobe will be offered to all centres in accordance with the liver allocation sequence.
4 The designated centres that are designated by NSCAG to carry out grafts in paediatric patients: (1) Birmingham Children’s Hospital, Birmingham in conjunction with Queen Elizabeth Hospital, Birmingham, (2) Kings College Hospital, London and (3) Freeman Hospital, Newcastle. Back...
D.3 ALLOCATION PRIORITY - PAEDIATRIC DONOR ISOLATED SMALL INTESTINE
3.1 All paediatric isolated small intestines donated in the UK and Republic of Ireland will be offered first for paediatric recipients and then for adults in the following priority order for Group 1 recipients at:
3.1.1 designated1 centres
in the UK or Republic of Ireland for paediatric recipients
in need of isolated small intestine graft;
3.1.2 designated2 centres in the UK or Republic
of Ireland for adult recipients in need of isolated small
intestine graft.
3.2 Offers will then be made to centres in the following priority order for Group 2 recipients at:
3.2.1 the designated zonal retrieval
centre;
3.2.2 designated centres in the UK or Republic of Ireland
for paediatric recipients;
3.2.3 non-designated centres in the UK or Republic
of Ireland for paediatric recipients;
3.2.4 the designated zonal retrieval centre for adult
recipients;
3.2.5 designated centres in the UK or Republic of Ireland
for adult recipients;
3.2.6 non-designated centres in the UK or Republic
of Ireland for adult recipients.
1 The designated centres are those designated by NSCAG to carry out small intestine grafts in paediatric patients: Birmingham Children's Hospital, Birmingham in conjunction with Queen Elizabeth Hospital, Birmingham.Back...
2 The designated centres are those designated by NSCAG to carry out small intestine grafts in adult patients: St James's Hospital, Leeds and Addenbrooke's Hospital, Cambridge.Back...
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.
D.4 THE LIVER ALLOCATION SEQUENCE
4.1 Donor organ offers for non Super Urgent recipients will be in accordance with the liver allocation sequence. The sequence first comprises designated centres, headed by the zonal retrieval centre, and secondly non-designated centres currently transplanting livers in the UK and Republic of Ireland.
4.1.1 The liver allocation sequence will be used to advise designated centres of the availability of a donor organ, regardless of whether a patient of the appropriate blood group is registered from their unit on the National Transplant Database at the time.
4.1.2 The liver allocation sequence will be sequenced according to each centre’s transplant activity, based on a rolling 4 week period (not including the most immediate week to allow for transplants to be recorded on the National Transplant Database). The centre with the least number of transplants during this period will appear top of the sequence, down to the centre with the most number of transplants.
4.1.3 Offers will be made to non-designated centres in accordance with the liver allocation sequence only when a suitable blood group recipient is registered from their unit on the National Transplant Database.
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1.1 The liver allocation sequence is sequenced according to each centre’s transplant activity in a 4-week period*, with units ranked in ascending order in accordance with the number of liver transplants performed in the time period. UKT will maintain the liver allocation sequence for each centre which will be calculated as follows:
1.1.1 *The 4-week period does not include the past week most immediate to the liver to be allocated. Instead, a one week window is used to allow the UK Transplant Duty Office to record liver transplants on the National Transplant Database. For example if a liver allocation sequence is produced on Saturday 20 May, the 4-week period used to determine a centre’s transplant activity will be to Saturday 15 April to Saturday 13 May
1.1.2 Livers transplanted from heartbeating, non-heartbeating and domino donors are included in the calculation. Livers offered and transplanted from donors from European Organ Exchange Organisations are included in the calculation.
1.1.3 Live liver transplants are not included in the calculation.
1.1.4 Centres with an identical activity count on the liver allocation sequence will be ranked in reverse-chronological order according to the date on which a transplant took place.
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F.1 FAST TRACK LIVER OFFER SCHEME - OFFERS
FROM THE UK AND REPUBLIC OF IRELAND
1.1 Liver units in the UK and Republic of Ireland are required to notify the UKT Duty Office of all livers that have not been placed four or more hours after retrieval. These livers will be offered to the remaining centres on the liver centre rota by the fast track offer scheme.
1.2 Non zonal livers accepted for a Super Urgent patient but not transplanted for recipient reasons and not accepted by the zonal centre, will be offered on the Fast Track Offer Scheme.
1.3 If not already offered, the UKT Duty Office will telephone the unit of a Super Urgent patient to give the offer verbally.
1.4 Livers offered on the fast
track offer scheme may be accepted for blood group compatible
or identical recipients: the usual blood group O priority
(see Section A.7) will be waived.
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The Scheme will operate as follows:
F.2 OPERATING THE FAST TRACK LIVER OFFER SCHEME - OFFERS FROM THE UK AND REPUBLIC OF IRELAND
2.1 Offers of livers meeting the criteria as described above, will be made by the UKT Duty Office to designated centres on the liver centre rota by simultaneous facsimile transmission of donor information.
2.2 In all cases centres must respond by telephone within 30 minutes to advise whether or not they wish to accept or decline the offer. If a centre does not respond to a fast-track offer, the UKT Duty Office will assume that the offer has been declined. The UKT Duty Office will follow-up those centres who fail to respond within the required 30 minutes to ascertain reasons why the offer was declined..
2.3 If a liver is accepted by more than one centre it will be allocated to the centre placed highest on the liver centre rota at the time of the offer.
2.4 Centres accepting for Group 2 patients must wait until the 30 minutes and follow-up have elapsed to ensure that no centre is accepting for a Group 1 patient.
2.5 Within 45 minutes of receiving
the referral, UKT will advise the offering centre of the outcome.
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F.3 FAST TRACK LIVER OFFER SCHEME - OFFERS FROM EUROPE
3.1 Designated Liver Units may
register with the UKT Duty Office to receive offers of livers
which are available from other units in Europe. The Scheme
will come into play for all offers of whole livers and liver
lobes from European Organ Exchange Organisations.
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The Scheme will operate as follows:
F.4 OPERATING THE FAST TRACK LIVER OFFER SCHEME - OFFERS FROM EUROPE
4.1 Offers of livers meeting the fast track offer scheme criteria will be made only to centres registered in the Scheme.
4.2 Offers will be made by UKT by simultaneous facsimile transmission of donor information.
4.3 For all cases, acceptance will be on a first come first served basis. Centres not responding will be deemed to have declined the offer.
4.4 Centres accepting for Group 2 patients must wait until the 30 minutes and follow-up have elapsed to ensure that no centre is accepting for a Group 1 patient.
4.5 Within 45 minutes of receiving
the referral, UKT will advise the offering European Organ
Exchange Organisation of the outcome.
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| Index | Paragraph Number |
|---|---|
| Allocation - Adult Donor Organs | C.2, C.3 |
| Allocation - Paediatric Donor Organs | D2, D3 |
| Balance of Exchange | E |
| - Calculation | E.1 |
| Blood Group 'O' Livers | A.7 |
| Contraindications | A.5 |
| Domino Livers | A.8 |
| Donor Definition - Adult | C.1 |
| Donor Definition - Paediatric | D.1 |
| Donor Information | A.4 |
| Fast Track Scheme | F |
| - Offers from the UK | F.1, F.2 |
| - Offers from Europe | F.3, F.4 |
| Group 1 and Group 2 Recipients | A.2 |
| Liver Centre Rota | C.4, D.4 |
| Non-heartbeating Donors | A.9 |
| Offering Time | A.6 |
| Paediatric Cases | A.3 |
| Registration of New Recipients | A.1 |
| Splitting of Livers | A.10 |
| Super Urgent Liver Scheme | B |
| - Diagnosis | B.1 |
| - Registration | B.2 |
| - Peer Review | B.3 |
| - Liver Scheme Ranking | B.4 |
| - Exceptions | B.5 |
