Chapter 5
KIDNEY DONATION In Australia, there were 63 kidney transplant recipients in 3, an increase of 9.7% since 9. Of the 63 kidney transplant procedures performed, there were nine double adult, six enbloc, thirty three combined kidney/ pancreas, one kidney/heart transplant and five kidney/liver recipients. In New Zealand, there were 55 kidney recipients including two double adult and one enbloc kidney and two combined kidney/pancreas transplant procedures. Figures 5. to 5.5 show the outcome of requests for kidney donation, the number of kidney transplants by donation pathway and the number of kidney recipients by jurisdiction, in Australia and New Zealand respectively. In particular figure 5.3 shows an increase in DCD kidneys from 6 to, and DBD kidneys from to 3 in Australia. Figure 5. Outcome of Request for Kidney Donation Australia 3 Figure 5. Outcome of Request for Kidney Donation New Zealand 3 5
Figure 5.3 5 35 DBD 35 Kidneys Transplanted by Type of Organ Donor Australia 998-3 33 373 DCD 38 36 36 3 8 377 36 3 88 55 Number 3 89 8 55 9 75 3 7 8 6 998 999 3 5 6 7 8 9 3 Figure 5. Kidneys Transplanted by Type of Organ Donor New Zealand 998-3 DBD DCD 8 Number 8 6 73 75 67 69 68 6 5 65 9 53 56 6 56 5 3 998 999 3 5 6 7 8 9 3 Figure 5.5 Deceased Donor Kidney Transplant Recipients* by Transplant State Australia and New Zealand -3 7 3 67 63 6 Number of Transplants 5 3 8 7 8 8 83 * 65 7 58 76 5 57 QLD NSW/ACT VIC/TAS SA/NT WA AUST* NZ *These numbers include the exchange of organ between States and Territories of Australia and New Zealand 5 3
In 3, there were 67 kidneys not retrieved from Australian donors and 7 from New Zealand donors. For Australia, the main reason was due to the kidney not being medically suitable (8), followed by no suitable recipient for the kidney(). In New Zealand all non-retrieved kidneys were due to not being medically suitable. Figures 5.6 and 5.7 show the non-utilisation rate of retrieved kidneys the proportion of kidneys that were retrieved for the purpose of solid organ transplantation, but not ultimately transplanted into a recipient (either due to an absence of suitable recipients, or the kidney being found to be medically or surgically unsuitable after retrieval). In Australia the non-utilisation rate remained steady at around 3% over -, but increased to 6.7% (95% CI.9 to 8.8) in 3. In New Zealand these rates have historically been generally higher than in Australia and rose to.9% in 3 from its lowest rate.5% in (note the different y-axis scales). By way of comparison, reported international non-utilisation rates were 3.5% in Spain for 3 and 9% in in the United States of America. The reasons why kidneys were not utilised for organ transplant is presented in Figure 5.9. (For the purpose of reliable reporting, re-categorisation of reasons has meant that previously reported values differ in some categories in past years reports.) Figure 5.6 Figure 5.7 Non-utilisation rate of retrieved kidneys Non-utilisation rate of retrieved kidneys Australia 9-3 New Zealand 9-3 % kidneys retrieved but not transplanted 8 6 % kidneys retrieved but not transplanted 3 9 3 9 3 Figure 5.9 Reasons Kidneys Retrieved and Not Utilised for Organ Transplantation in Australia (New Zealand) 9-3 Year Logistics Medically Unsuitable Surgically Unsuitable No Suitable Recipient Other Total 9 (6) () 3 5 (7) 8 (6) 5 6 (6) 9 3 () 9 () 8 () 7 9 () 3 3 3(3) 7 3 6 (3) Footnotes: Memorias de acividad - ONT 3 OPTN/SRTR Annual Data Report 5
AGE OF KIDNEY DONORS The age distribution of donors providing transplanted kidneys for Australia and New Zealand is shown in Figures 5. and 5. respectively. Figure 5. Figure 5. Age of Donors Providing Transplanted Kidneys Age of Donors Providing Transplanted Kidneys Australia 3 New Zealand 3 5 Donors (335) 3 Donors (3) Percent Percent 5 3 5 6 7 8 Donor age 3 5 6 7 8 Donor age Includes 335 Kidney Donors Includes 3 Kidney Donors DONOR KIDNEY FUNCTION AUSTRALIA In 3, in Australia, 9 donors (%) had a terminal serum creatinine concentration of 5 µmol/l and 33 donors (9%) had a terminal serum urea concentration of 9 mmol/l, shown in Figure 5.. NEW ZEALAND There were four donors (%) in New Zealand with a terminal serum creatinine concentration of 5 µmol/l and no donors with a terminal serum urea concentration of 9 mmol/l in 3. Figure 5. Terminal Serum Creatinine Levels 9-3 Creatinine Australia New Zealand (µmol/l) 9 3 9 3-99 77% 78% 76% 75% 79% 87% 9% 8% 87% 8% - 9% 6% % 9% 7% 5% 3% 9% % 6% 5-9 5% % 5% 5% % 5% 3% 6% 3% 6% 5-7 % % 3% % 3% 3% 3% - - 3% 75-99 % % % % % - - - - - - % % % % % - - 3% - - 5-9 % % % % % - - - - 3% >= 5 % 3% % % % - - - - - DONOR KIDNEY BIOPSY In donors (.7%) a biopsy of the kidneys was taken at the time of retrieval in 3 in Australia and ten donors (%) in New Zealand. Since, there have been 399 (.%) biopsies from 3,7 kidney donors in Australia and 6 (3.8%) from 6 kidney donors in New Zealand. 5 5
LIVER DONATION In 3, there were 3 livers retrieved providing 5 recipients with transplanted livers from Australian donors and 5 retrievals in New Zealand providing for 6 recipients, as shown in Figure 5.3 and 5.. This was an increase of 6.5% for liver transplant procedures since 9. There were five combined liver/kidney transplants and one liver/ lung transplant in Australia. Thirty eight partial liver transplants, from 9 donors, were performed in Australia using the split liver technique (transplanting one liver into two recipients) and there were seven reduced size livers transplanted into paediatric recipients. Figure 5.3 Outcome of Request for Liver Donation Australia 3 + Figure 5. Outcome of Request for Liver Donation New Zealand 3 + + Each portion of a partial liver is counted once. 5 6
Figures 5.5 and 5.6 show the number of recipients of liver transplants by type of organ donor pathway in Australia and New Zealand respectively from 998 to 3. Figure 5.5 Recipients of Liver Transplantation by Type of Organ Donor Australia 998-3 Number 5 5 38 3 DBD 7 8 57 DCD 36 76 6 6 9 8 9 3 5 998 6 8 999 3 5 7 9 3 3 7 Figure 5.6 Recipients of Liver Transplantation by Type of Organ Donor New Zealand 998-3 3 9 8 DBD 3 9 3 DCD 3 36 3 8 3 3 33 8 3 5 Number 998 6 8 999 3 5 7 9 3 5 7
Figure 5.7 compares the number of deceased donor liver recipients, by state and country, for and 3. Figure 5.7 Deceased Donor Liver Transplant Recipients* by Transplant State Australia and New Zealand, -3 3 3 Number of Transplants 5 5 5 5 7 73 8 6 65 3 7 8 3 3 QLD NSW/ACT VIC/TAS SA/NT WA AUST* NZ *These numbers include the exchange of organ between States and Territories of Australia and New Zealand There were 5 livers not retrieved from Australian donors in 3 and from New Zealand donors. For Australia, the main reasons were the liver not being medically suitable (73), followed by age of donor (7) and DCD (). In New Zealand mostly non-retrieved livers were due to being not medically suitable (9). Figure 5. tabulates the reasons livers were not used after retrieval for the purpose of transplantation since 9. Figure 5. Reasons Liver Retrieved and Not Utilised for Organ Transplantation in Australia (New Zealand) 9-3 Year Logistics Medically unsuitable Surgically unsuitable No Suitable Recipient Other Total Whole Liver 9 3 3 5 () 6 () 3 6 () () 5 8
AGE OF LIVER DONORS The age of donors providing transplanted livers for Australia and New Zealand are shown in Figures 5. and 5. respectively. Figure 5. Figure 5. Age of Donors Providing Transplanted Livers Australia 3 Age of Donors Providing Transplanted Livers New Zealand 3 5 Donors (33) 3 Donors () Percent Percent 5 3 5 6 7 8 Donor age 3 5 6 7 8 Donor age DONOR LIVER FUNCTION The results of the serum tests for liver function for 3 Australian and New Zealand donors in 3 who had livers retrieved, are shown below. There were 8% of donors in Australia (95) and 86% of donors in New Zealand (9) who had all five tests performed. Figure 5.3 shows the number of donors whose liver function was above the normal range. Figure 5.3 Number of Donors with Liver Function Tests above Normal Range 3 Australia New Zealand Liver Function Tests Donors with value recorded * Above Normal Donors with value recorded * Above Normal Alanine Transaminase ALT > u/l 3 97 9 Aspartate Transaminase AST > u/l 95 5 9 8 Gamma Glutamol Transferase GGT > 6 u/l 6 9 7 Alkaline Phosphatase > 6 u/l 33 5 Total Bilirubin > umol/l 3 5 * Not all donors have all tests 5 9
HEART DONATION In 3, there were 77 heart transplant recipients and two heart/double lung transplant recipients. This was an increase of almost 3% for heart transplants since 9. New Zealand performed nine heart transplants in 3. This number has been relatively stable since. Figures 5.5 and 5.6 show the outcome of request for heart donation in Australia and New Zealand for 3 respectively. Figure 5.5 Outcome of Request for Heart Donation Australia 3 Figure 5.6 Outcome of Request for Heart Donation New Zealand 3 5
Figures 5.7 and 5.8 show the number of recipients of heart transplants in Australia and New Zealand respectively from 998 to 3. Figure 5.7 Recipients of Heart Transplants by Year Australia 998-3 Number of Transplants 9 8 7 6 5 3 73 67 59 69 8 68 78 78 76 6 85 6 68 66 76 79 998 999 3 5 6 7 8 9 3 Includes Heart/Lung Transplants Figure 5.8 Recipients of Heart Transplants by Year New Zealand 998-3 3 5 Number of Transplants 5 5 3 3 5 9 6 6 9 9 5 998 999 3 5 6 7 8 9 3 Includes Heart/Lung Transplants 5
Figure 5.9 Figure 5.3 8 Deceased Donor Heart Transplant Recipients* by Transplant State Australia and New Zealand, -3 3 7 77 5 Deceased Donor Heart-Lung Transplant Recipients* by Transplant State Australia and New Zealand, -3 3 Number of Transplants 6 3 5 5 3 3 7 9 Number of Transplants 3 3 QLD NSW/ACT VIC/TAS SA/NT WA AUST* NZ *These numbers include the exchange of organ between States and Territories of Australia and New Zealand QLD NSW/ACT VIC/TAS SA/NT WA AUST* NZ *These numbers include the exchange of organ between States and Territories of Australia and New Zealand In 3, there were 65 hearts not retrieved from Australian donors and from New Zealand donors. For Australia, the main reason was due to the heart not being medically suitable (76), followed by no suitable recipient for the heart (35) and age of donor (8). In New Zealand, eight hearts were not retrieved as they were medically unsuitable and two due to no suitable. AGE OF HEART DONORS The age of donors providing transplanted hearts for Australia and New Zealand are shown in Figures 5.33 and 5.3 respectively. Figure 5.33 Figure 5.3 Age of Donors Providing Transplanted Hearts Australia 3 Age of Donors Providing Transplanted Hearts New Zealand 3 Donors (79) 7 Donors (9) 6 5 5 Percent Percent 3 5 3 5 6 7 8 Donor age 3 5 6 7 8 Donor age Includes Heart-Lung Donors Includes Heart-Lung Donors ECG AND ECHOCARDIOGRAM In Australia, 69 donors (7%) had a normal ECG and 76 of the 9 heart donors (8%), had a normal echocardiogram. In New Zealand, eight of the nine heart donors had a normal ECG and all nine had normal echocardiogram. 5
LUNG DONATION In 3, in Australia, there were 69 lung transplant recipients, 6 double lung, five single lung recipients and two heart/double lung recipients. This represents a 8% increase in lung transplants since 9. In New Zealand 8 double lung transplants occurred in 3. Figure 5.35 Outcome of Request for Lung Donation Australia 3 Figure 5.36 Outcome of Request for Lung Donation New Zealand 3 * 5 3
Figures 5.37 and 5.38 show the number of recipients of lung transplants by type of organ donor pathway in Australia and New Zealand respectively from 998 to 3. Figure 5.37 Recipients of Lung Transplants by Type of Organ Donor Australia 998-3 5 DBD DCD 39 8 3 Number 79 65 86 7 87 65 9 78 9 65 96 93 5 7 33 6 8 998 6 8 999 3 5 7 9 3 8 7 6 Figure 5.38 Figure 5 5.9 Recipients of Lung Transplants by Type of Organ Donor New Zealand 998-3 DBD DCD 3 8 6 6 Number 5 9 9 3 3 3 3 5 998 6 8 999 3 5 7 9 3 5
Figure 5.39 Deceased Donor Lung Transplant Recipients* by Transplant State Australia and New Zealand, -3 3 69 Number of Transplants 5 5 6 39 5 8 59 7 9 9 QLD NSW/ACT VIC/TAS WA AUST* NZ# *These numbers include the exchange of organ between States and Territories of Australia and New Zealand. #One recipient was transplanted on -Jan-3 and donated on 3-Dec-. In 3, there were 6 lungs not retrieved from Australian donors and nine from New Zealand donors. For Australia, 6 lungs were not medically suitable, 8 had no suitable recipient, eight due to trauma to the organ and seven were not used due to age of donor. In New Zealand, seven were not medically suitable, one each of no suitable recipient and trauma to organ. Figure 5. shows the reason lungs were not used from Australian deceased donors since 5. In New Zealand only one lung in 9 was not transplanted, due to no suitable recipient being available. Figure 5. Reasons Lungs Retrieved and Not Utilised for Organ Transplantation in Australia (New Zealand) 9-3 Year Logistics Medically Unsuitable Surgically Unsuitable No Suitable Recipient Other Total 5 6 7 8 3 9 5 3 3 3 5 5
AGE OF LUNG DONORS The age distribution of donors providing transplanted lungs for Australia and New Zealand is shown in Figures 5.3 and 5. respectively. Figure 5.3 Figure 5. Age of Donors Providing Transplanted Lungs Australia 3 Age of Donors Providing Transplanted Lungs New Zealand 3 5 Donors (67) 5 Donors (8) Percent 5 Percent 3 3 5 6 7 8 Donor age 3 5 6 7 8 Donor age Includes Heart-Lung Donors Includes Heart-Lung Donors DONOR LUNG FUNCTION AUSTRALIA NEW ZEALAND There were 8 Australian lung donors (6%) who had a bronchoscopy in 3. Sixteen donors had chest trauma; these included nine pneumothorax, four with a chest drain, two with fractured ribs and one with an effusion. The arterial blood gases were taken on % FiO and PEEP of 5 cm. Fifty six donors had a PEEP > 5 cm (33%). The results from 69 lung donors in 3 show % (8) to be acidotic (ph < 7.35) and 7% (8) to be alkalotic (ph > 7.5). Oxygenation measured as PaO ranged from 3-93 mmhg with a median of mmhg. PaCO ranged from.7-5. mmhg with a median of 37.9 mmhg. There were four (%) New Zealand lung donors who had a bronchoscopy in 3. No donors had chest trauma. All 8 lung donors had % FiO; six had a PEEP greater than 5cm. The arterial blood gas results from nine lung donors in 3 show 39% (7) to be acidotic (ph < 7.35) and two donors (%) to be alkalotic (ph > 7.5). Oxygenation measured as PaO ranged from 39-539 mmhg with a median of 379 mmhg. PaCO ranged from 3. - 39. mmhg with a median of 38. mmhg. 5 6
PANCREAS DONATION There were 33 whole pancreas recipients in 3, all as combined kidney/pancreas transplants ( in New South Wales and 3 in Victoria). In addition, there was one pancreas islets transplant performed in New South Wales. In New Zealand in 3, there were no pancreas retrieved for transplantation. Figure 5.5 Outcome of Request for Pancreas Donation Australia 3 * Figure 5.6 Outcome of Request for Pancreas Donation New Zealand 3 5 7
Figures 5.7 and 5.8 show the number of recipients of Pancreas transplants by type of organ donor pathway in Australia and New Zealand respectively from 998 to 3. Figure 5.7 Recipients of Whole Pancreas Transplant by Type of Organ Donor Australia 998-3 DBD DCD 37 37 33 3 3 3 33 3 6 5 5 8 7 6 Number 8 7 998 6 8 999 3 5 7 9 3 Figure 5.8 Recipients of Whole Pancreas Transplant by Type of Organ Donor New Zealand 998-3 8 DBD DCD 6 6 6 Number 3 3 3 3 3 998 6 8 999 3 5 7 9 3 5 8
Figure 5.9 Deceased Donor Pancreas Transplant Recipients* by Transplant State Australia and New Zealand, -3 5 3 Number of Transplants 3 8 3 QLD NSW/ACT VIC/TAS SA/NT WA AUST* NZ *These numbers include the exchange of organ between States and Territories of Australia and New Zealand. 38 33 In 3, there were pancreas not retrieved from Australian donors and from New Zealand donors. For those pancreas not retrieved in Australia, 7 were not medically suitable, 9 due to age of donor, 3 due to logistical issues, 5 due to no suitable recipient being available, a result of DCD donation, four due to trauma to organ and two surgically unsuitable. In New Zealand, it was mostly due to no suitable recipient being available (6) and age of donor (). Sixty-eight donors in 3 had pancreas retrieved, however 6 of those were not for the purpose of organ transplantation but rather retrieved for research purposes. Figure 5.5 shows the reasons pancreas were not used from Australian deceased donors since 5. In New Zealand only one pancreas in 9 was not transplanted, due to no suitable recipient being available. Figure 5.5 Reasons Pancreas Retrieved and Not Utilised for Organ Transplantation in Australia 9-3 Year Logistics Medically Unsuitable Surgically Unsuitable No Suitable Recipient Other Total 9 3 3 5 9
AGE OF PANCREAS DONORS The age of donors providing transplanted pancreas for Australia are shown in Figures 5.53. Figure 5.53 5 Age of Donors Providing Transplanted Pancreas Australia 3 Donors (3) Percent 3 3 5 6 7 8 Includes Pancreas Islet Donors Donor age PANCREAS ISLETS DONATION Pancreas islet transplantation is a procedure in which islets from the pancreas of the deceased organ donor are purified, processed and transplanted into a recipient. This procedure is performed only in people with Type Diabetics where blood glucose levels are difficult to control. In Australia and New Zealand, the total number of pancreas islet transplants performed, since this experimental procedure began in is 69. In 3, one person received a pancreas islet transplant. Of all pancreas retrieved in 3, five pancreas islets were not used for transplantation due to insufficient islets and a further 3 pancreas retrieved were used for pancreas islets research. Figure 5.5 Recipients of Pancreas Islet Transplant by Type of Organ Donor Australia 998-3 5 DBD DCD 9 9 Number 5 6 3 7 5 998 6 8 999 3 5 7 9 3 5
INTESTINE DONATION Adult and paediatric patients with irreversible intestinal failure and developing severe complications from parenteral nutrition can benefit from intestinal transplantation. Only two intestinal transplants have been performed in Australia; this is not yet a widespread treatment for irreversible intestinal failure. The first successful intestinal transplant was performed at the Austin Hospital in Victoria, Australia in. Figure 5.55 Intestine Transplanted by Type of Organ Donor Australia 9-3 Number 9 3 5
Suggested Cita on: ANZOD Registry, Annual Report, Chapter 5: Organ Data. Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia.. Available at: h p://www.anzdata.org.au C-\ Royal Adelaide Hospital East Wing 9th Floor North Terrace, Adelaide South Australia Australia www.anzdata.org.au This page is inten onally blank