Influence of retransplantation on organ allocation

Abstract

In spite of continuous improvement in transplant techniques and patient management there are still a significant number of graft failures affecting every kind of solid organ transplantation. Graft failure after kidney transplantation makes more demanding to find another compatible organ for that patient. More dramatic, primary failure of heart or liver graft is a medical emergency that jeopardizes the patient’s life. Retransplantation has been associated with a decreased patient and graft survival for each type of transplant considered [1–4], and significantly increases the cost of the overall process [5,6]. The inclusion on waiting list (WL) of patients considered for retransplantation might carry a decreased chance of getting an organ for those awaiting a primary graft. Given the shortage of transplantable organs, some authors have advocated that previous transplant history should be taken in account when setting the criteria for organ allocation as it is done with ABO blood group matching [5,7]. Other have been willing to limit the number of organs available for retransplantation [8] and even completely to ban retransplantation procedures [9] as the way to preserve fairness and justice in the transplantation process.