Key points

• 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 standardized and as a result there has been a year-on-year improvement in 1-year survival. Most recipeints die because of co-morbidity 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. In 2008, 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, utilization and fairness

Introduction

Solid organ (liver, pancreas and kidney) transplantation is an important treatment modality for end-stage organ failure. Indeed if a vital organ such as the liver fails, transplantation is the only management option currently available.

Organ transplantation increases life expectancy and quality of life (for the recipient and their family), but is not without risk.