A further peculiarity of the Norwegian living donor program is that no patient with end-stage renal disease is put on the DD wait list before the possibility of a LD has been thoroughly evaluated. In other words, the DD wait list should be reserved for those patients who do not have the opportunity of receiving a LD graft. The availability of a sufficient amount of organs in Norway can only be made possible by the extensive use of LDs over time. Countries that traditionally do not use LDs will typically only be able to supply an organ to one third of those on the wait list. The Norwegian Ministry of Health has concluded that neither the Oviedo directive of the Council of Europe nor the organ directive of the European Union are legally in conflict with the Norwegian practise.²

After more than 7300 renal transplantations, of which over 2700 were with a kidney from a living donor, 72% of the Norwegian uremic population is successfully transplanted at any given time. This is the highest coverage compared to other countries. In 2011, the total transplantation rate per million was 60.4, including all kidney sources (Fig. 25.2).

This is made possible by the high rate of LDs, averaging 37% over the years of the program. There is no age limit for transplantation or dialysis in Norway . Patients that are deemed unsuitable for transplantation at primary evaluation will, among other things, be offered heart-, aortic-, or carotid artery surgery where indicated, in order to make them eligible. Norway has a universal health care system. Dialysis also belongs to this public system and there are no private dialysis units in Norway . Recipients and potential LDs are processed at the 20 local nephrology centres in Norway and then referred to one national transplant centre for final approval and TX.

This one transplant centre, which handles all types of transplantations, covers the needs of 5 million Norwegians making it the largest centre of its kind in Scandinavia. All organ harvesting is also performed by the surgeons in this centre. Simple logistics lead to reduced costs and the second shortest average cold ischemia time in Scandinavia, despite long distances that need to be travelled for both organ retrieval and for patients coming to Oslo to receive their transplant.

Norway is a member and one of the founders of Scandiatransplant , which serves as a centralized computer system for all of Scandinavia and also controls the organ exchange within Scandinavia according to an agreed set of rules. This system gives supranational preference to children , patients with especially complicating antibodies and has also introduced a permissible mismatch program. Initially, the rate of exchange of organs among Scandinavian countries was approximately 25 %, giving special preference to HLA matching. Within recent years, the rate of exchange has been reduced to between 5–10 %. Less emphasis has been put on HLA matching and more on short cold ischemia time, which results in more organs being used locally and further acts as a motivating factor for the transplant teams. These guidelines are available on the Scandiatransplant homepage. In that some Scandinavian countries have a higher transplantation rate than others and while recipient wait lists also vary, a system to avoid an imbalance within Scandiatransplant has been developed, in which organs of comparable quality have to be returned to the donor country within half a year. Before this system was introduced, Norway was losing a significant amount of organs each year.