National Adult Intestinal Transplant forum, which convenes every two months. New Zealand has a formalised process for appeals to the National Renal Transplant Leadership Team. 1.6 Ongoing review Factors affecting patient suitability for transplantation may change over time. For this reason, patients wait-listed for organ transplantation should be monitored by their local physician. In addition, patients should be reviewed by the transplant unit (i) regularly, at an interval determined by the transplant unit based on patient comorbidity profile and stability (typically annually), AND (ii) ad-hoc, when the transplant unit is alerted to a potential change in suitability by the patient’s usual treating physician or other medical staff. For example, unscheduled hospitalisations, intercurrent events such as myocardial infarction, or concerns with respect to non-adherence to therapy may warrant ad-hoc review by the transplant unit. If, upon review, the patient is determined to be no longer suitable for transplantation, they should be (i) delisted, if the change in status is deemed likely to be permanent, or (ii) temporarily moved to the inactive list, if the problem identified is felt to be remediable—in this case a plan for reassessment with a view to reinstatement to the active list should be made. The patient and their referring physician should be kept informed of any changes in listing status and, subsequently, of the steps involved in determining suitability for reinstatement to the active list. 1.7 Retransplantation Organ transplant recipients who develop failure of the transplanted organ (e.g. a kidney transplant recipient who develops failure of the transplanted kidney) or another organ (e.g. a patient with a functioning liver transplant who develops kidney failure) are entitled to be assessed and listed for transplantation of a subsequent organ. The assessment should determine medical eligibility and the likelihood of successful transplantation in the same way as those seeking transplantation of a first organ. The presence or absence of a previous transplant should not affect access to transplantation, except where this impacts upon medical suitability.15 April 2021 version 1.5 5 References 1 Mehra MR, Kobashigawa J, Starling R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates—2006. J Heart Lung Transplant, 2006;25(9):1024–42. 2 Macdonald P. Heart t Organ donor eligibility The majority of transplantation in Australia and New Zealand is possible because of deceased donation, including all heart, lung, pancreas, most liver, and approximately 70% of all kidney transplantation.1 Deceased donation is based on altruistic decisions of individuals and/or their families to donate organs to benefit other people. In Australia and New Zealand, as in all countries, there are more people who might benefit from organ transplantation than there are donor organs available. This is largely due to the small proportion of people who die in the specific circumstances under which organ donation is currently medically feasible (approximately 1% of hospital deaths). The framework within which deceased organ donation occurs includes the laws and regulations that govern the determination of death and the use of human organs and tissues for transplantation, as well as the policies and guidelines that direct clinical practice. 2,3,4,5 2.1 The organ donation process 2.1.1 Prerequisites for deceased organ donation Before organ donation can take place: • The donor must have been declared deceased by qualified physicians using accepted guidelines that are consistent with the laws and regulations of the jurisdiction in which the donor has died (see ANZICS statement), and • Consent to organ donation must have been given and documented according to the laws and regulations of that jurisdiction. It is the formal responsibility of a designated officer appointed by the hospital authorities, reinforced by the Donation Specialist Coordinator and all surgeons in charge of donor surgical teams, to confirm that these laws and regulations have been fully complied with and documented appropriately before proceeding to the retrieval of organs. 2.1.2 Determination of death and pathways to organ donation Criteria for declaring death in Australia and New Zealand are: 2,5 • Irreversible cessation of all function of the brain of the person, or • Irreversible cessation of the circulation of blood in the body of the person. Death declared according to neurological criteria (brain death) is only possible when the person is maintained on a mechanical ventilator, usually whilst receiving treatment in an intensive care unit (ICU). Conditions causing sufficient brain injury to culminate in brain death include haemorrhagic or occlusive stroke, trauma, hypoxicischaemic brain injury following a cardiac arrest, central nervous system infections and tumours. There are strict criteria and procedures for the determination of brain death in Australia and New Zealand, which are outlined in the clinical guidelines of the Australian and New Zealand Intensive Care Society.2 Donation after brain death (DBD) provides the best conditions for organ donation, since more of the donor’s organs are suitable for transplantation compared to donation after cessation of circulation. DBD also results in better transplant outcomes for some organs, and the DBD