OPTN/SRTR 2011 Annual Data Report: international data.

For the first time, OPTN/SRTR has undertaken to publish global transplant rates as part of its Annual Data Report. Understanding why rates vary from country to country may lead to a better understanding of how to improve access to transplant everywhere. Availability of information varies substantially from country to country, and how complete and accurate the data are is difficult to ascertain. For Canada, Malaysia, and the United Kingdom, data were supplied at SRTR request from well-known registries. For many other countries, SRTR was unable to obtain information, and data from the World Health Organization's Global Observatory on Donation and Transplantation were used. Transplant counts and rates vary substantially around the world, likely due to 1) differences in rates of end-organ diseases, 2) economic differences in the ability to provide transplants or other end-organ disease treatment, 3) cultural differences that might support or hinder organ donation and transplant, and 4) reporting differences.

OPTN/SRTR 2011 Annual Data Report: pancreas.

Numbers of pancreas transplants have been decreasing over the past decade, but outcomes continue to improve for all types: simultaneous pancreas-kidney transplant, pancreas after kidney transplant (PAK), and pancreas transplant alone (PTA). The most notable decrease occurred for PAK transplants, possibly due in part to decreases in numbers of living donor kidney transplants. The number of new candidates on the pancreas transplant waiting list has decreased steadily since 2000; only 1005 active candidates were added in 2011. Transplant rates for all pancreas transplant types reached a low in 2011 of 34.9 transplants per 100 wait-list years. Deceased donation rates have also been decreasing since 2005, but use of donation after circulatory death has been gradually increasing. The discard rate in 2011 was 27.7%, and higher for pancreata recovered from older donors. Improved outcomes during the early posttransplant period largely reflect improved donor and recipient selection and improved technical strategies. Inconsistent definitions of graft failure across reporting centers creates an ongoing challenge in the interpretation of outcome data for pancreas transplants. Rates of posttransplant re-hospitalization are high, most occurring in the first 6 months. Rejection rates are highest for PTA recipients, who also experience higher incidence of posttransplant lymphoproliferative disorder.

Lung and heart allocation in the United States.

Lung and heart allocation in the United States has evolved over the past 20-30 years to better serve transplant candidates and improve organ utilization. The current lung allocation policy, based on the Lung Allocation Score, attempts to take into account risk of death on the waiting list and chance of survival posttransplant. This policy is flexible and can be adjusted to improve the predictive ability of the score. Similarly, in response to the changing clinical phenotype of heart transplant candidates, heart allocation policies have evolved to a multitiered algorithm that attempts to prioritize organs to the most infirm, a designation that fluctuates with trends in therapy. The Organ Procurement and Transplantation Network and its committees have been responsive, as demonstrated by recent modifications to pediatric heart allocation and mechanical circulatory support policies and by ongoing efforts to ensure that heart allocation policies are equitable and current. Here we examine the development of US lung and heart allocation policy, evaluate the application of the current policy on clinical practice and explore future directions for lung and heart allocation.