Revisiting multi-organ transplantation in the setting of scarcity.

TitleRevisiting multi-organ transplantation in the setting of scarcity.
Publication TypeJournal Article
Year of Publication2014
AuthorsReese PP, Veatch RM, Abt PL, Amaral S
JournalAm J Transplant
Volume14
Issue1
Pagination21-6
Date Published2014 Jan
ISSN1600-6143
KeywordsAdult, Child, Heart Transplantation, Humans, Kidney Transplantation, Liver Transplantation, Organ Transplantation, Pancreas Transplantation, Patient Selection, Quality of Life, Resource Allocation, Tissue and Organ Procurement, Treatment Outcome, Waiting Lists
Abstract

In the setting of organ scarcity, the ethics of multi-organ transplantation (MOT) deserve new examination. MOT offers substantial benefits to certain recipients, including avoiding serial surgeries. However, MOT candidates in the United States commonly receive priority for their nonprimary organ over many individuals who need that organ, which may undermine equity. The absence of standard criteria for MOT eligibility also enables large and unfair regional variation in MOT, such as simultaneous liver-kidney transplantation. Unfortunately, MOT may also undermine utility (optimal patient and graft survival) in circumstances where providing multiple organs to one person fails to achieve the greater collective benefit attained by providing transplants to multiple people. Policy reforms should include the adoption of minimal clinical criteria for MOT candidacy with the attendant goal of decreasing regional variation in MOT. In the future, these minimal criteria can be revised to accommodate new research about which patients derive the most benefit from MOT. Incentives to perform MOT should also be reduced, such as by including MOT outcomes in center-specific reports. These reforms run the risk that the transplant community could be perceived as abandoning MOT candidates, but offer an opportunity to align transplant practice and ethical principles.

DOI10.1111/ajt.12557
Alternate JournalAm. J. Transplant.
PubMed ID24354869