[Allocation problems in organ transplantation: practical medical experience]

Abstract

Solid organ transplantation is one the most successful medical innovations of the 20th century. Due to an increasing number of patients on the waiting lists for transplantation in the context of persisting organ shortage the aim of optimal allocation policy is the best possible balance between medical urgency and postoperative outcome. Because of scientific evolution and increasing waiting list mortality the allocation system for liver transplantation was altered in December 2006. As intended, the preferential treatment of sicker patients resulted in a reduced waiting list mortality. On the other hand, an unintentional decrease in postoperative survival was observed. This obvious imbalance between medical urgency and postoperative outcome has led to the current allocation problem. Several scientific approaches for optimising allocation policy will be presented and discussed in this paper. Finally, continuous review and adaptation will be a persisting challenge for people working in the field of solid organ transplantation.