international report on - home - godt€¦ · kidney transplants from deceased and living donors...

1

INTERNATIONAL REPORT ON

Organ Donation and Transplantation Activities

Executive summary

2017

http://www.transplant-observatory.org/

October 2019

2

3

Contents

Results

1. TOTAL / GLOBAL TRANSPLANT ACTIVITY ...........................................................4

2. PATIENTS TRANSPLANTED …………………………………………………………………………...10

3. ACTUAL DECEASED DONOR ACTIVITY..................................................................12

4. KIDNEY ACTIVITY ..........................................................................................................17

5. LIVER ACTIVITY .............................................................................................................22

6. HEART ACTIVITY ...........................................................................................................27

7. LUNG ACTIVITY .............................................................................................................31

8. PANCREAS ACTIVITY ..................................................................................................35

9. SMALL BOWEL ACTIVITY ..........................................................................................39

10. TRANSPLANTS BY GENDER………………………………………………………………………….43

Methods and definitions ..……………………………………………………………………………………………………47

Acronyms ................................................................................................................................................49

Disclaimer ...............................................................................................................................................50

Acknowledgements .............................................................................................................................51

4

Total / Global Transplant Activity

5

6

Kidney Liver Heart Lung Pancreas S. bowel

90,306 32,348 7,881 6,084 2,243 162

Global Activity in organ transplantation

Estimations 2017

139,024 ORGAN TRANSPLANTS

7

82 Member States, which represent 75 % of the global population, reported to the Global Observatory on Donation and Transplantation (GODT) for 2017.

Only one reporting country did not have any transplant activity at all.

Organ Transplant activities performed in 2017, although impressive, barely cover 10% of the global needs.

Member States with any transplant activities showed a large variability in rates pmp.

Percentages of transplanted organs in 2017

Kidneys and Livers are the more frequent therapeutic op-tions (65% and 23% respectively), while small bowel transplants are very infrequent.

65%

23%

6%

4%

2% 0%

Kidney

Liver

Heart

Lung

Pancreas

Small bowel

8

Transplant activity per type of organ (pmp). 2017

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Small Bowell tx pmpPancreas tx pmp Total Lung tx pmpHeart tx pmp Total Liver tx pmpTotal Kidney tx pmp

9

139,024 TRANSPLANTS PERFORMED IN 2017

380 TRANSPLANTS / DAY

16 TRANSPLANTS / HOUR

10

Patients transplanted

11

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Tx recipients from LD pmp

Tx Recipients from DD pmp

135,686 patients were reported to be transplanted in 2017

Patients transplanted (pmp). 2017

12

Actual Deceased Donor Activity

13

14

2263 2410 2486 25615188 6892 7985

23010 23377 23550 2424525586 27962 29462

8,9 9,3 9,5 9,5

16,919,8 21,3

0

10

20

30

40

50

60

70

80

90

100

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 2012 2013 2014 2015 2016 2017

actual DBD actual DCD %DCD

Absolute numbers of DCD and DBD. Percentage of DCD. Global data. 2011-2017

78.7% donors after brain death

DBD: 70 countries

DCD: 25 countries 37,447 25,273

15

0.0 10.0 20.0 30.0 40.0 50.0

Philippines (n=12)Guatemala (n=2)

Nicaragua (n=1)Malaysia (n=13)

India (n=773)Bosnia&Herzegovina (n=3)

Japan (n= 111)Bol ivia (n=10)

Dom Republic (n=14)Kazakhstan (n=24)South Africa (n=91)

Peru (n=52)Paraguay (n=11)

Qatar (n=8)Saudi Arabia (n=104)

Romania (n=65)China (n=5146)

Rep of Moldova (n=16)Mexico (n=509)

Russia (n=572)Panama (n=17)

Thailand (n=294)Costa Rica (n=22)

Kuwait (n=20)Ecuador (n=83)

Greece (n=67)Bulgaria (n=43)

Singapore (n=39)Turkey (n=554)

Cyprus (n=10)Colombia (n=437)

Chile (n= 173)Germany (n=797)

Rep of Korea (n=515)Israel (n=92)

Cuba (n=142)Latvia (n=24)

Argent ina (n=593)Lith uania (n=40)

Estonia (n=18)Poland (n=560)

Luxembourg (n=9)Netherlands (n=258)New Zealand (n=73)

Slovakia (n=86)Brazil (n=3420)

Hungary (n=159)Switzerland (n=145)

Denmark (n= 103)Uruguay (n=66)Sweden (n=192)

Iceland (n=6)Slovenia (n=43)Ireland (n=99)

Austra lia (n=510)Finland (n=118)Norway (n=116)

Canada (n=802)UK (n=1492)

Belarus (n=224)Austria (n=213)

Czech Republic (n=269)Ita ly (n=1714)

F rance (n=1933)Malta (n= 12)

Belgium (n=348)USA (n=10286)

Croatia (n=140)Po rtugal (n=351)

Spain (n=2183)

Actual DBD pmp

Actual DCD pmp

Deceased donors (pmp). 2017

12 countries out

of 82 did not

have any DD in

2017

16

Actual donors after circulatory death (DCD): Absolute number and Rate (pmp). 2017

7,985 DCD (21.3 % of the total number of Actual deceased organ donors).

N = 25 countries

17

Kidney activity

18

19

Note – Rates are estimated by using the global population as the denominator.

Evolution of Kidney Transplant activities worldwide (absolute numbers and rates pmp).

2011-2017

76118 77818 78952 79948 84347 89823 90306

11 11.1 11.2 11.111.3

12.1 12.01

0

2

4

6

8

10

12

14

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

2011 2012 2013 2014 2015 2016 2017

Kidney Tx (Absolute Number) Kidney Tx pmp

36% from living donors in 2017

20

Absolute numbers of Kidney transplants from DD and from LD.

Percentage of LD. Global data. 2011-2017

90,306 76,118

21

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Eth

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Nig

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Hon

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Chi

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Gre

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rus

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Ric

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Jord

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itSl

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enia

Ge

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Me

xico

Lit

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an

iaL

atv

iaIc

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nd

Est

on

iaS.

Ara

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Slo

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Bra

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Po

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ntin

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ryIt

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Bel

aru

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N. Z

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zerl

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Isra

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ep

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ralia

De

nm

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Swe

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UK

Ma

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in

Kidney transplants from deceased and living donors (pmp). 2017

81 countries reported kidney transplants (deceased and /or living). Only 13 countries (Armenia, Ethiopia, Georgia, Honduras, Jordan, Iceland, Kenya, Mongolia, Nigeria, N.Macedonia, Pakistan, Sudan and Syria) reported to have only living kidney transplants.

22

Liver activity

23

24

Evolution of the Liver Transplant activities (total numbers and rates pmp).

2011-2017

2372123986 25029

2615127759

3035232348

3.4 3.43.5

3.63.7

4.14.3

0

1

2

3

4

5

0

5000

10000

15000

20000

25000

30000

35000

2011 2012 2013 2014 2015 2016 2017

Liver Tx (Absolute Number) Liver Tx pmp

Note – Rates are estimated by using the global population as the denominator.

19% from living donors in 2017

25

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Liver transplants from deceased, living donors and domino (pmp). 2017

65 countries reported liver transplants (deceased and /or living). 13 countries reporting domino transplants: Belgium, Brasil, France, Germany, Italy, Japan, Portugal, Romania, Spain, Sweden, Switzerland, UK and USA.

26

Absolute numbers of Liver transplants from DD, from LD and Domino.

Percentage of LD. Global data. 2011-2017

32,348 23,727

27

Heart activity

28

29

Evolution of the

Heart Transplant activities

(total numbers and rates pmp).

2011-2017

Note – Rates are estimated by using the global population as the denominator.

5741 5935 6270 65427023

7626 78810.8 0.8

0.9 0.90.9

1 1

0

0.5

1

1.5

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

2011 2012 2013 2014 2015 2016 2017

Heart Tx (Absolute Number) Heart Tx pmp

30

Heart Transplants (pmp). 2017

0.0 2.0 4.0 6.0 8.0 10.0 12.0

Malaysia (n=1)Romania (n=3)

India (n=237)Panama (n=1)Mexico (n=33)

Thailand (n=21)Peru (n=10)

China (n=446)Paraguay (n=3)

Latvia (n=1)South Africa (n=31)

Singapore (n=4)Bulgaria (n=5)

Greece (n=8)Costa Rica (n=4)

Turkey (n=75)Kazakhstan (n=19)

Saudi Arabia (n=37)Colombia (n=75)

Russia (n=252)Brazil (n=380)

Chile (n=36)Uruguay (n=7)

Israel (n=18)Netherlands (n=38)

Lithuania (n=7)Poland (n=98)

Argentina (n=117)UK (n=191)

Germany (n=257)Slovakia (n=18)

Ireland (n=16)Rep of Korea (n=184)

Australia (n=98)Belarus (n=39)

Denmark (n=25)Italy (n=265)

Portugal (n=46)Switzerland (n=40)

Finland (n=26)N Zealand (n=24)

Hungary (n=52)Canada (n=215)Norway (n=32)Sweden (n=62)Spain (n=304)

Belgium (n=79)Czech Rep (n=74)

France (n=473)Austria (n=64)Croatia (n=33)USA (n=3273)

Slovenia (n=24)

Heart tx pmp

53 countries reported heart trans-

plant activities in 2017.

Slovenia, followed by USA, pre-

sented the highest rate pmp with

more than 10 heart transplants

per million inhabitants (11.4 and

10.09 respectively).

31

Lung activity

32

33

Note – Rates are estimated by using the global population as the denominator.

Evolution of the Lung Transplant activities (total numbers and rates pmp). 2011-2017

4278 4359 4834 4689 5046 5497 6084

0.6 0.6

0.70.65

0.7 0.7

0.8

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

0

1000

2000

3000

4000

5000

6000

7000

2011 2012 2013 2014 2015 2016 2017

Lung Tx (Absolute Number) Lung Tx pmp

34

Lung Transplant activities (pmp). 2017

0.00.00.00.00.10.20.20.20.30.3

0.50.50.50.50.5

0.90.91.01.1

1.71.8

2.22.4

3.03.3

3.83.83.8

4.24.34.44.4

5.96.1

6.66.66.6

7.57.6

7.88.6

9.510.6

13.3

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0

Thailand (n=1)Mexico (n=4)

Peru (n=1)Malaysia (n=1)India (n=106)

South Africa (n=9)Russia (n=25)

China (n=299)Kazakhstan (n=5)

Lithuania (n=1)Colombia (n=24)

Turkey (n=40)Japan (n=66)Belarus (n=5)Brazil (n=112)

Chile (n=17)Argentina (n=42)

Poland (n=39)Saudi Arabia (n=37)

Uruguay (n=6)Rep of Korea (n=93)

Hungary (n=21)Italy (n=144)

UK (n=198)Portugal (n=34)

Germany (n=309)Switzerland (n=32)

Estonia (n=5)Czech Rep (n=44)N Zealand (n=20)

Netherlands (n=74)Finland (n=24)France (n=384)

Denmark (n=35)Sweden (n=65)Norway (n=35)

Israel (n=55)Ireland (n=36)USA (n=2478)Spain (n=363)

Australia (n=210)Canada (n=348)Belgium (n=121)Austria (n=116)

Lung Tx pmp

44 countries reported Lung transplants.

99.8 % of the transplants were from deceased donors while only eleven procedures were re-ported from living donors : Japan (n=10) and

Brazil (n=1).

According to the rates, a total of 12 coun-tries showed rates > 5.0 pmp, and 32 lower

than 5.0 pmp.

Austria had the highest activity (13.3 pmp) followed by Belgium (10.6 pmp).

35

Pancreas activity

36

37

2564 2423 2474 2328 2299 2342 2243

0.4

0.35

0.30.3 0.3 0.3 0.3

0

0.1

0.2

0.3

0.4

0.5

0

500

1000

1500

2000

2500

3000

2011 2012 2013 2014 2015 2016 2017

Pancreas Tx (Absolute Number) Pancreas Tx pmp

Note – Rates are estimated by using the global population as the denominator.

Evolution of the Pancreas Tx activities (total numbers and rates pmp). 2011-2017

A continuous slight decrease is observed in the last years of compilation of data.

38

Pancreas Transplant activities (pmp). 2017

0.0

0.0

0.3

0.50.5

0.6

0.6

0.7

0.91.0

1.1

1.2

1.4

1.51.5

2.0

2.32.3

2.52.6

3.13.7

3.84.5

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0

India (n=18)Peru (n=1)

South Africa (n=2)Russia (n=6)

Dominican Republic (n=1)Colombia (n=13)

Japan (n=43)Chile (n=9)

Brazil (n=111)Saudi Arabia (n=18)

Switzerland (n=5)Hungary (n=6)

Belarus (n=6)Italy (n=39)

Kuwait (n=3)N Zealand (n=4)Germany (n=72)

Ireland (n=5)Poland (n=41)

Israel (n=9)Croatia (n=5)

Rep of Korea (n=62)Belgium (n=14)

Argentina (n=62)Netherlands (n=25)

France (n=96)Spain (n=70)

Denmark (n=9)Australia (n=49)Canada (n=76)Austria (n=20)

Estonia (n=3)Sweden (n=25)

Portugal (n=27)UK (n=202)

USA (n=1002)Czech Rep (n=39)

Finland (n=21)Norway (n=24)

Pancreas tx pmp

39 countries reported pancreas

transplants.

The three countries with the

highest rates are Norway (4.5

pmp) followed by Finland (3.8

pmp) and Czech Republic (3.7

pmp).

39

Small bowel activity

40

41

Note – Rates are estimated by using the global population as the denominator.

Evolution of Small bowel Transplant activities (total numbers and rates pmp). 2011-2017

209 169 174 215 196 220 162

0.03

0.02 0.02

0.03 0.03 0.03

0.02

0

0.01

0.02

0.03

0.04

0

50

100

150

200

250

2011 2012 2013 2014 2015 2016 2017

Small bowel Tx (Absolute Number) Small bowel Tx pmp

42

Small bowel Transplant activities (pmp). 2017

Only 15 countries reported to perform

small bowel transplants. A total of 162

were reported for 2017, although it

seems to be quite underestimated.

The rates vary from 0.02 to 0.34 pmp.

USA is the country with the highest ra-

te (0.34 pmp) followed by UK (0.27

pmp).

0.0 0.1 0.1 0.2 0.2 0.3 0.3 0.4 0.4

India (n=1)

Brazil (n=1)

Turkey (n=2)

Saudi Arabia (n=1)

France (n=2)

Germany (n=3)

Australia (n=1)

Czech Rep (n=1)

Argentina (n=5)

Canada (n=5)

Spain (n=8)

Sweden (n=2)

Belgium (n=3)

UK (n=18)

USA (n=109)

Small Bowell tx pmp

43

Transplants by Gender

44

Patients transplanted by gender (%). 2017

0% 20% 40% 60% 80% 100%

Cyprus (n=19)Guatemala (n=112)

Latvia (n=51)Bol ivia (n=82)

Kazakhstan (n=295)Ecuador (n=187)

Kuwait (n=89)Uruguay (n=184)

Dominican Rep (n=56)Argent ina (n=1999)

New Zealand (n=285)Peru (n=218)

Colombia (n=1307)Netherlands (n= 1262)

Norway (n=452)Hungary (n=441)

Belarus (n=491)Estonia (n=50)

Russia (n=1890)Slovakia (n=203)

Poland (n=1612)Czech Republic (n=835)

Denmark (n=372)UK (n=4871)

Mexico (n=3386)Singapore (n= 143)

USA (n=33508)Iceland (n=8)

Costa Rica (n=107)Germany (n=3285)

Switzerland (n=577)Turkey (n=4892)Bulgaria (n=58)Brazil (n=8538)

Thailand (n=871)Cuba (n=225)

Sweden (n=783)Austria (n=761)

Rep of Korea (n=3984)Israel (n=520)

Malaysia (n=86)Greece (n=212)

Finland (n=351)Spain (n=5152)

Panama (n=53)Ita ly (n=3951)

North Macedonia (n=17)Qatar (n=58)

Rep of Moldova (n=31)Philippines (n=526)

Malta (n=21)Portugal (n=865)

Slovenia (n=90)Paraguay (n=44)

Croatia (n=314)Lithuania (n=106)

Sudan (n=214)Nigeria (n=132)Armenia (n=11)Georgia (n=31)

% Male recipients % Female recipients

In brackets, absolute number of recipients provided by gender

33,540 female recipients (36.7%)

57,734 male recipients (63.2%)

N= 60 countries

45

0 10 20 30 40 50 60 70 80 90 100

Nicaragua (n=1)Costa Rica (n=22)

Rep of Moldova (n=16)N Zealand (n=73)

Bolivia (n=10)Norway (n=116)Panama (n=17)Slovenia (n=43)

Singapore (n=39)Australia (n=510)

Kazakhstan (n=24)Germany (n=797)Denmark (n=103)

Paraguay (n=11)Netherlands (n=258)

Sweden (n=192)Hungary (n=159)Lithuania (n=40)

Finland (n=118)Luxembourg (n=9)

Croatia (n=140)France (n=1933)

Ireland (n=99)Japan (n=111)

Brazil (n=3420)United Kingdom (n=1492)

Italy (n=1714)Austri a (n=213)Greece (n=67)

Peru (n=52)Spain (n=2183)

Romania (n=65)USA (n=10286)

Bulgaria (n=43)Chile (n=173)

Switzerland (n=145)Portugal (n=351)

Israel (n=92)Czech Republic (n=269)

Rep of Korea (n=515)Argentina (n=593)

Uruguay (n=66)Turkey (n=554)Mexico (n=509)Poland (n=560)

Cuba (n=142)Colombi a (n=437)

Malta (n=12)Belarus (n=224)

Russia (n=572)Slovakia (n=86)Ecuador (n=83)

Latvia (n=24)Estonia (n=18)

Thailand (n=294)Dom Republic (n=14)

Kuwait (n=20)Saudi Arabia (n=104)

Iceland (n=6)Philippines (n=12)

Malaysia (n=13)Guatemala (n=2)

Qatar (n=8)Bosnia&Herzegov (n=3)

% Male DD % Female DD

Deceased Donors by gender (%). 2017

In brackets, absolute number of Total DD provided by gender

12,164 female actual donors (40.2%)

18,113 male actual donors (59.8%)

N= 64 countries

46

0 10 20 30 40 50 60 70 80 90 100

Slovakia (n=11)Czech Republic (n=51)

Bulgaria (n=8)Portugal (n=79)

Greece (n=68)Finland (n=29)Poland (n=80)

Malaysia (n=56)Peru (n=46)Italy (n=328)Latvia (n=13)

Hungary (n=40)Cyprus (n=9)

Norway (n=77)Armenia (n=11)Spain (n=349)Iceland (n=8)

N Zealand (n=72)USA (n=6170)

Sweden (n=128)Argentina (n=435)Nicaragua (n=10)

Panama (n=15)Belarus (n=12)

Uruguay (n=19)Russia (n=332)

Australia (n=273)United Kingdom (n=1034)

Denmark (n=92)Mexico (n=2249)

North Macedonia (n=17)Paraguay (n=19)Lithuania (n=6)

Singapore (n=56)Slovenia (n=2)

Turkey (n=3736)Kazakhstan (n=235)

France (n=60)Kuwait (n=60)Ecuador (n=9)Bolivia (n=61)Sudan (n=214)

Costa Rica (n=53)Estonia (n=5)

Japan (n=1891)Thailand (n=201)

Israel (n=235)Rep of Korea (n=2292)Rep of Moldova (n=3)

Cuba (n=29)Malta (n=8)

Qatar (n=41)% Male LD % Female LD

11,211 female actual donors (52.5%)

10,126 male actual donors (47.4%)

N= 52 countries

In brackets, absolute number of LD provided by gender

Living Donors by gender (%). 2017

47

Methods and definitions

An ad hoc standard questionnaire for the activities related to organ donation and transplantation practices is

annually distributed to the identified health authorities and focal points contributing to the global database.

The definitions applied for the completion of the standardized questionnaire are derived from the WHO Glob-

al Glossary on Donation and Transplantation, which is accessible at http://www.transplant-observatory.org/

download/global-glossary/ or through the WHO website (http://www.who.int/transplantation/activities/en/). Defini-

tions and explanations about how to complete the questionnaire can be found at the Global Observatory on Do-

nation and Transplantation website (http://www.transplant-observatory.org/ ).

In summary,

Actual donor (=donor): a deceased person from whom at least one organ has been recovered for the purpose of organ removal.

DBD donor: a deceased donor whose death has been determined by neurological criteria.

DCD donor: a deceased donor whose death has been determined by circulatory criteria.

48

Transplants are counted as those performed only within the country.

Counts for the multiorgan or double organ transplants are counted as follows:

Counts for the number of recipients transplanted: For more than one organ transplanted into the same recipi-

ent, count as one recipient.

Specific indicators have been added to the questionnaire along the years, in order to provide further infor-

mation about the donation and transplantation activities performed around the globe.

The data provided correspond to the period from January 1st to December 31st 2017.

The progression bars represent rates that have been estimated by using the global population as the denomi-

nator. This approach provides a better estimation of the accessibility of the global population to transplant thera-

One double kidney transplant is considered as one transplant.

One heart-lung transplant is counted as one lung transplant and one heart transplant.

One double lung transplant is considered as one transplant.

One Kidney-pancreas transplant is counted as one kidney transplant and one pancreas transplant.

As a novelty, information about the gender data is presented for first time in the annual report. Some select-ed data provided by gender are shown, only for those countries that reported this type of information and when the figures were > 0.

49

pies.

To calculate rates per million inhabitants, the State of World Population reports, from the United Nations

Population Fund (UNFPA), has been used as the source to estimate the population size.

Data were analysed using descriptive statistics. Statistical analysis was performed with SPSS software (version

25.0) and the Excel tool was used for the creation of bar charts.

The official maps are annually produced by the Information Evidence and Research (IER) Department at

WHO, derived from a datasheet of the Global Database.

Acronyms

It should be noticed that the previous GODT Reports used the most recent available national figures to avoid missing data. However, only the responding countries for 2017 have been included in this report. Therefore com-parative analysis with previous years should be treated with caution.

DBD: Actual donors after brain death

DCD: Actual donors after circulatory death (DCD)

DD: Actual deceased organ donors

LD: Living organ donors

GODT: Global Observatory on Donation and Transplantation

ONT: Organización Nacional de Trasplantes, Spain

pmp: per million inhabitants

Tx: Transplants

WHO: World Health Organization

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Disclaimer The data and information presented here are published in order to promote transparency in transplantation

activities.

Whenever possible this information has been confirmed by official national sources. However, in some instances,

there are still provisional estimates. It is therefore anticipated that some data presented may be modified without

prior notice.

As the facts displayed here are not definitive, they cannot be reproduced or quoted unless shown with the ap-

propiate warning and the date.

For any references to this report, the following should be quoted: Organ Donation and Transplantation Activi-

ties 2017 Report. Global Observatory on Donation and Transplantation (GODT).

For citations of the 2017 GODT data please quote the following: Those 2017 data are based on the Global Ob-

servatory on Donation and Transplantation (GODT) data, produced by the WHO-ONT collaboration.

For any references in Charts and bar chart please quote: * Data of the WHO-ONT Global Observatory on Do-

nation and Transplantation.

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Acknowledgements

The GODT team is grateful to the identified focal points in Member States for their valuable contribution to the

database, the Council of Europe for its contribution through the Newsletter Transplant and the Information Evi-

dence and Research (IER) Department at WHO for the production of the global maps.

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