Chapter 30: Basic Outline of Solid Organ Transplantation

The following sections are included:

• Solid organ transplantation is now commonplace and is the standard of care for patients with end-stage organ failure.

• Indications have changed over time and there are few absolute contraindications.

• Equity of access to transplant waiting lists is paramount and selecting the correct recipient and donor pair will optimise the outcome.

• The surgical techniques for all organ transplantation are now well established and standardised, and as a result there has been a year-on-year improvement in 1-year survival. Most recipients die because of comorbidity or poor organ function.

• Live donor transplantation for both kidney and liver recipients has become an extremely important source of donor organs.

• Complications are general to surgical patients, but indeed each organ has its own specific risks.

• Immunosuppression has advanced hugely over the past 10 years and, as a result, the overall attrition rate due to acute rejection has reduced considerably.

• The biggest problem facing transplantation today is the donor shortage. Over the next 5 years the organ donor taskforce set up by the Minister of Health has set out a plan to increase donation by 50%.

• Until this happens, transplantation will always have to deal with the ethical dilemmas of allocation, utilisation and fairness.