[Grafts: what safety for what risks?].

Abstract

Grafting is a rather complex technology with various indications such as end-stage organ failure or simple tissue repair. From graft procurement to transplantation, numerous risks are connected step by step from the careful surgical indication, the donor and the recipient selection, to the graft preservation, processing and implantation. The whole procedure needs a real risk management. Preventive measures cannot eliminate all risks. Clinical surveillance is necessary to prevent the transmission of opportunistic infections and the delayed effects of the immunosuppressive medication. The concept of risk/benefit is a basic public health approach in organ transplantation. The medical team needs relevant epidemiological data to balance risk and benefit. The recipient requires to be able to give a comprehensive consent. The goal is clear: the risk must decrease and the benefit must raise up and concern more people. The acceptance of a risk/benefit challenge supposes an epidemiological surveillance system; all the data about adverse events must be collected for a comprehensive epidemiological analysis. On the contrary, in tissue transplantation, safety must be maximum because, in most of the cases, the treatment permits only to improve the quality of life. In terms of research, according to the organ shortage, potential ways raise up such as medical devices or xenotransplantation. But xenotransplantation carries out some other doubts, ethical, philosophical and medical.