[Transplantation today].

Abstract

Purpose of this review is, to highlight key issues in transplantation medicine today and to summarise basic information on current state of perfused organ transplantation. There is special emphasis on ethical and legal considerations with regard to living donor transplantation, brain death concept, donor consent and organ allocation. Transplantation frequencies and the impact of whole organ transplantation on the treatment concept for patients with end stage organ disease is heavily dependent on donor and organ availability. Organ donor rate of 25 to 30 donors per million inhabitants per year seems to yield sufficient organ supply for patients on renal replacement therapy. 15 to 20 liver transplantations per million inhabitants per year, my be sufficient, to cover the need of organs for non malignant end stage liver diseases. This frequency may be achieved by increasing donor rates and employing "split techniques", where one liver is used for two recipients. One year graft survival in kidney transplantation can be expected to be between 85 and 90%, one year patient survival in heart and liver transplantation can be expected to be beyond 80%. The risk of organ failure is highest in the first year, long term results are dependent on incidence of chronic rejection, comorbidity of the patient and original disease. Patient- and/or graft loss after the first year is in the order of 1 to 5%. Whole organ transplantation for kidneys, hearts and livers are considered routine procedures, lung transplantation is reaching standard phase, pancreas and combined pancreas kidney transplantation is well established technically, but its indication is still controversial.