EU lacks cross border cooperation in access to transplants, experts warn

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With the EU’s shortage of organs for transplants creating growing waiting lists, experts and doctors have highlighted the need for more cooperation between member states and more transparency regarding organ waiting lists.

Kidneys, for patients suffering from kidney failure, followed by lungs, livers and hearts, are the most common organs needed for transplants.

In 2021, in the EU, there were 15,684 kidney transplants, 6,483 liver transplants, 2,026 heart transplants and 1,711 lung transplants, according to European Commission figures.

While this comes to a total of about 26,000 transplants, there are double the amount of patients still on the waiting list (52,000), as demand for available organs far outstrips supply.

With such extended waiting times, clear and reliable information must be made available, Professor Thomas Mueller of Zürich Hospital said during a hybrid event organised by the Spanish presidency of the EU Council on Thursday and Friday (9-10 November).

“The access and the allocation of transplants on the waiting list of patients should be very transparent. There should be a clear procedural process for how a patient is put on the waiting list, how a patient is treated, and there should be traceability,” Mueller said.

Shortages mainly concern kidneys. At the end of 2021, almost 10,000 patients from Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, the Netherlands and Slovenia were waiting for a kidney transplant, according to Eurotransplant data. However, fewer than 3,000 kidneys were transplanted that year across the countries mentioned.

Mueller highlighted the need for more cooperation between EU countries, insisting that “cross-border collaboration” would facilitate transplants and help patients find available organs.

According to him, every country should be self-sufficient and match the needs of its own population.

Spain: EU and world leader

Regarding access to transplants, Spain stands out as an exception, with the country currently leading in both world and European metrics in the transplant sector.

In 2020, there were around 37 organ donors per million inhabitants in Spain. By way of comparison, in 2019, this figure was 11 donors per million inhabitants for Germany, 25 for Italy and less than 30 for France, according to Esanum, a social network for doctors and scientists.

One of the reasons for this success is the number of doctors trained and skilled for realising transplants.

“More than 10,000 emergency professionals and nearly 2,000 ICU residents have been trained in the last 15 years,” said Daniel Gallego, from the European Kidney Patients’ Federation and the European Kidney Health Alliance, at the event organised by the Spanish presidency.

In total, Spain has nearly 200 medical centres in which organ donation is available. But there is a wide range of disparities between the different regions of the country, as is the case in other member states – and some regions only have minor centres.

As such, Spain has also developed mobile teams of doctors to make donations possible in all minor centres around the country. The teams are composed of “a surgeon, a transplant coordinator, and a perfusionist”, Gallego said.

The mobile teams have reduced the waiting list from six months in 2016 to approximately three months in 2023.

Support from the Commission

Despite organ donation and transplants being specific to each member state and depending on their health system, the European Commission is seeking ways to support European countries at the EU level.

“The European Commission is supporting national competent authorities (NCAs) by facilitating the sharing of information between them, including guidance from the European Centre for Disease Prevention and Control (ECDC), particularly during the COVID-19 crisis,” the EU executive said in a press release.

For example, the ECDC draws up plans for managing epidemic outbreaks where blood, tissues, cells and organs are detected. Recently, its latest assessments have focused on the Ebola virus, West Nile virus, Zika virus and hepatitis A.

The Commission and EU lawmakers are also working on the revision of safety and quality standards for substances of human origin (SoHO). The Spanish EU Council Presidency hopes to find a provisional deal before the presidency ends on 31 December.

All transplantations should have standards of care “as high as possible in every country” without “any compromise”, Mueller concluded.

[Edited by Giedrė Peseckytė/Nathalie Weatherald]