Scandiatransplant Activities and Awards in 2023

Scandiatransplant is the organ exchange organization serving Denmark, Finland, Iceland, Norway, Sweden, and Estonia. They facilitate kidney, liver, thoracic, pancreas, and islet transplantations. The organization aims to maintain transparency and ethical practices while operating a common waiting list to optimize organ allocation. In 2023, several grants were awarded for research in solid organ transplantation.

• Scandiatransplant
• Organ Exchange
• Transplantation
• Awards
• Grants

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2. Slideshow 2023 Scandiatransplant activities Slide presentation of Scandiatransplant activities Presentation, purpose, awards and office Slide 3 Organ procurement and transplantation activities in Scandiatransplant Slide 8 Kidney Transplantation Slide 14 Liver Transplantation Slide 26 Thoracic Transplantation Slide 30 Pancreas and Islet Transplantation Slide 41

3. Scandiatransplant Scandiatransplant is the organ exchange organization for the countries Denmark, Finland, Iceland, Norway, Sweden and Estonia. It covers a population of about 29,5 million inhabitants. It is owned by the eleven hospitals performing organ transplantation in these countries. The office is located at Aarhus University Hospital, Denmark.

4. Purpose of Scandiatransplant to serve as a common organ exchange organisation and allocation resource for its member hospitals including kidney, liver, heart, lung, pancreas, pancreatic islet, liver cells, composite graft, intestinal and multivisceral transplantation. This is done transparently, using ethical principles and in full compliance with the national legislation of the members countries, to maintain and operate a common waiting list for transplantation, to ensure complete traceability from organ donors to patients, to maintain and operate follow-up registries of transplanted patients, to maintain and operate follow-up registries of living donors, to serve as a collaborative platform through specialized working groups and advisory groups in order to facilitate best practice recommendations and policies optimizing retrieval, allocation and transplantation of organs, and to form a collaborative network for the member hospitals to promote research and development related to organ donation, allocation and transplantation.

5. Reykjavik Oslo Gothen- burg Uppsala Stock- holm Sk ne Copen- hagen Odense Aarhus Helsinki Tartu Council of Representatives NKG NLTG Chair Board SHLG N TG NTCG Medical Director Scandiatransplant office STTG SIDG NTC Scandiatransplant IT system YASWA

6. Awarded Grants in 2023 Travel Grants Reseach Grants Principal investigator: Marie Skougaard: "Unravelling immunological mechanisms of unexplained graft rejection by in silico HLA epitope matching in solidorgan transplantation a proof-of-concept trial exploring the relevance of HLA epitope matching". Supported with 362.000 DKK From Reykjavik: Sigridur Sigurdardottir was granted 9.000 DKK Stella Hrafnkelsdottir was granted 9.000 DKK From Stockholm: Tx coordinators were graned 24.000 DKK Principal investigator: Kathe Meyer: "Care in Organ Donation - relatives' and ICU personnel's perspectives". Supported with 150.000 DKK From Helsinki: Jenni Kippola was granted 8.000 DKK Nina Peltonen was granted 8.000 DKK Eppu Jetsonen & Tito Saarinen were granted 5.000 DKK From Aarhus: Laura Knudsen was granted 17.500 DKK

7. Scandiatransplant Office Activities 2023 Customize the IT-system to the user s wishes and optimizing security and functionality of the system. Incorporating more deceased donor functionalities and variables in the IT-system, so that people involved in the donation process are continuously updated with relevant information and documentation is securely stored electronically. Moving from Oracle database management system to PostgreSQL. Providing real-time statistics on donors, transplantations and waiting lists Revision of all extractions and reports Educate users and comply with demands from users, owners, researchers and the public. Arrange and participate in meetings for groups, committees, board and council of representatives. Take care of finance and personnel.

8. 2023 Organ procurement and transplantation activities in Scandiatransplant

9. Scandiatransplant 2023 678 Utilized deceased donors (22,96 PMP) Organ transplants performed 1440 kidneys (284 were kidneys from living donors) 448 livers (1 was liver from living donor ) 151 hearts 193 lungs (2 heart-lung) 62 pancreas (51 as combined kidney-pancreas) 8 pancreatic islet 3 intestine (2 multiviceral) 2422 patients on waiting list at the end of 2023

10. Patients entered on waiting list during 2023 (2022 figures) Kidney Liver Heart Lung Pancreas Kidney + Pancreas Liver + Kidney Pancreatic Islets TOTAL 1338 (1237) 452 (441) 150 (161) 178 (149) 4 (5) 60 (29) 18 (7) 10 (8) 2210 (2029)

11. Utilized deceased donors PMP 35 1993-1997 1998-2002 2003-2007* 2008-2012 2013-2017** 2018 2019 2020 2021 2022 2023 30 Number of deceased donors 25 20 15 10 5 0 Denmark Finland Norway Sweden Iceland Estonia *Iceland: only numbers from 2004 and onwards **Estonia: only numbers from oct. 2017 and onwards

12. Yearly flow on the waiting list 3000 2500 Number of patients Entered during the year 2000 Transplanted recipients during the year 1500 On waiting list at end of year 1000 500 0 1999 2001 2005 2007 2009 2011 2013 2015 2017 2019 2021 2023 2003

13. Deceased donor organ exchange between centers in 2023 30% 25% 20% 15% 10% 5% 0% Kidney Liver Heart Lung Notes: Only organs not used for combined transplantations are included Organs exchanged due to local/national agreements are not included

14. Kidney Transplantation

15. Kidney Transplantation 1989 2023 1400 1200 Number of transplants 1000 800 600 400 200 0 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019 2021 2023 Deceased donors Living donors

16. Kidney exchange rate in % between centers 1969 - 2023 80 70 60 50 40 30 20 10 0 1971 2009 1969 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2011 2013 2015 2017 2019 2021 2023 Notes: Only organs not used for combined transplantations are included Organs exchanged due to local/national agreements are not included

17. Kidney Transplantation activity 2023 by centre 350 300 Number of transplants 250 200 Living donor Deceased Donor 150 100 50 0

18. Kidney Transplantation PMP 2023 70 60 50 Living donor 40 Deceased donor 30 20 10 0 Denmark Finland Norway Sweden Iceland Estonia

19. Kidney Transplantation 2023 100% 90% 80% 70% 60% Living donor 50% 40% Deceased donor 30% 20% 10% 0%

20. Number of patients on the kidney waiting list at the end of the year 1995 - 2023 2500 2000 Number of patients 1500 1000 500 0 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019 2021 2023

21. Average months on kidney waiting list at end of year (including patients active and on hold) 40 1999-2004 35 2005-2009 2010-2014 30 Number of months 2015 25 2016 2017 20 2018 15 2019 2020 10 2021 5 2022 2023 0 Denmark Finland Norway Sweden Estonia

22. Average months on kidney waiting list by immunisation status at end year 50 2002-2007 45 2008-2012 40 2013 Number of months 2014 35 2015 30 2016 25 2017 20 2018 2019 15 2020 10 2021 5 2022 0 2023 High immunized Immunized Prev. immunized Non immunized

23. Deceased donor kidney transplants 1994 - 2023 1994-1999 450 2000-2004 400 2005-2009 Number of transplants 350 2010-2014 300 2015 250 2016 2017 200 2018 150 2019 100 2020 50 2021 0 2022 Denmark Finland Norway Sweden Figures included from Estonia year 2017 starts from October 1st 201 Estonia 2023

24. Living donor kidney transplants 1994 - 2023 180 1994-1999 2000-2004 2005-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 160 140 Number of transplants 120 100 80 60 40 20 0 Denmark Finland Norway Sweden Iceland Estonia

25. Kidney exchange obligations Patient with STAMP-status that are ABO compatible with donor and where all donor HLA-A, -B, -C -DRB1, -DRB3/4/5, DQA1, -DQB1, -DPA1 -DPB1 antigens are either shared with the recipient or are among those defined as acceptable. Highly immunized (PRA 80%) patients who are HLA-A, -B, -DRB1 compatible with donor. Immunized patients (PRA 10% but below 80%) who are HLA-A, -B, -DRB1 compatible with donor. If organ donor is <50 years of age, at least one kidney is offered to recipient <16 years of age (counted from time of registration) if there is HLA-DRB1 compatibilitty and in addition not more than 2 HLA-A, B mismatches. Patients who are HLA-A, -B, -DRB1 compatible with donor unless the proposed recipient is > 30 years older than the donor. 1. 2. 3. 4. 5. Priority 1: Donors are matched ABO-compatible Priority 2-5: Donors are matched ABO-identical, with the exception of donors of blood group A, which also can be exchanged to recipients of blood group AB.

26. Liver Transplantation

27. Liver Transplantation 1989 - 2023 500 18 450 16 400 14 350 12 300 10 250 8 200 6 150 4 100 2 50 0 0 1995 2008 2021 1989 1990 1991 1992 1993 1994 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2022 2023 Number (columns) PMP (line)

28. Liver Transplantation 1994-2023 250 1994-1999 2000-2004 2005-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 200 Number of transplants 150 100 50 0 Denmark Finland Norway Sweden Figures included from Estonia year 2017 starts from October 1st 20 Estonia

29. Exchange criteria Liver Exchange obligation to highly urgent patients: acute liver failure acute liver re-transplantation highly urgent patients that needs to be transplanted within 72 hours Exchange obligation to pediatric (<18 years at entry on liver waiting list) and visceral recipients if donor liver fulfils split criteria Return (payback) liver to donor centre Rota system for spare livers

30. Thoracic Transplantation

31. Thoracic transplantation 2023 90 80 Number of transplants 70 60 Heart 50 Lung 40 30 Heart-Lung 20 10 0 Denmark Finland Norway Sweden Estonia

32. Heart Transplantation 1989 - 2023 180 7.0 160 6.0 140 5.0 120 4.0 100 80 3.0 60 2.0 40 1.0 20 0 0.0 2003 2010 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2004 2005 2006 2007 2008 2009 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Number PMP

33. Heart transplantation 2023 80 70 Number of transplants 60 50 40 30 20 10 0 Denmark Finland Norway Sweden

34. Heart Transplantation 1994 - 2023 80 1994-1999 2000-2004 2005-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 70 Number of transplants 60 50 40 30 20 10 0 Denmark Finland Norway Sweden

35. Number of patients on the heart waiting list at the end of the year 1989 - 2023 140 120 Number of patients 100 80 60 40 20 0 2007 1989 1991 1993 1995 1997 1999 2001 2003 2005 2009 2011 2013 2015 2017 2019 2021 2023

36. Exchange criteria Heart Exchange obligation to highly urgent patients on waiting list: Patient on short-term assist devices (ECMO, centrifugal pump). Patient on para corporeal or implantable blood pump with device failure or uncontrollable device infection. Patients below 16 years on continuous inotropic support (also including home treatment) or more than 12 months support on implantable long-term VAD (in-hospital or at home). Hospital-bound patients < 25 kg supported by long- term VAD may be priority 0 listed 90 days after implantation, even in the absence of major VAD complications. Rota system for exchange of hearts between countries.

37. Lung transplantation 1990 - 2023 including heart-lung 200 180 Number of transplants 160 140 120 100 80 60 40 20 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022

38. Lung Transplantation 1994 - 2023 100 1994-1999 2000-2004 2005-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 90 80 Number of transplants 70 60 50 40 30 20 10 0 Denmark Finland Norway Figures included from Estonia year 2017 starts from October 1st 201 Sweden Estonia

39. Number of patients on the Lung waiting list at the end of the year 1990 2023 160 140 Number of patients 120 100 80 60 40 20 0 2000 1990 1992 1994 1996 1998 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022

40. Exchange criteria Lung Exchange obligation to highly urgent patients on waiting list Priority 0: Patient on extra-corporeal circulatory support (ECMO, Novalung or other device) or ventilatory support*. Priority 1: Patient with a rapid progression of organ failure with poor prognosis in a short time defined by the responsible centre*. *max. three patients per centre per year (Tartu one per year). Rota system for exchange of lungs between countries.

41. Pancreas and Islet Transplantation

42. Exchange recommendations Pancreas If there is no suitable recipient in own centre, the pancreas (and kidney if SPK) is recommended to be offered to AB0 compatible recipients in other centres. The centre at the highest position on the rota list accepting the pancreas will receive it and be put last. Shipment of a kidney is only performed if no other kidney exchange obligation with higher priority (as defined by Scandiatransplant) exists. The receiving centre has the responsibility for the pancreas procurement. The receiving centre has to payback, as soon as possible, with an AB0 identical kidney of a quality acceptable to the recipient centre. There is no mandatory payback for the pancreas.

43. Pancreas Transplantation 1988 2023 100 3.5 90 3.0 80 2.5 70 60 2.0 50 1.5 40 30 1.0 20 0.5 10 0 0.0 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 Number PMP

44. Islet Transplantation 1997-2023 25 1 0.9 20 0.8 0.7 15 0.6 0.5 10 0.4 0.3 5 0.2 0.1 0 0 1999 2006 1997 1998 2000 2001 2002 2003 2004 2005 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Number PMP

45. Thank you