General Principles

• Solid organ transplantation is a treatment, not a cure, for end-stage organ failure of the kidney, liver, pancreas, heart, and lung. Small intestine and vascularized composite allografts are performed in smaller numbers at specialized centers throughout the country. The benefits of organ replacement coexist with the risks of the immediate procedure followed by the risks of chronic immunosuppression. Thus, not all patients with organ failure are transplant candidates.
• Organs from deceased donors remain in short supply, with increasing waiting times for potential recipients. Living donor transplants are common in kidney transplantation and are being evaluated in liver and lung transplantations as a partial solution to this shortage. Xenotransplantation (transplantation of animal tissue into humans) is not currently a viable option.
• Immunologic considerations between donor and recipient prior to the transplant must be fully evaluated including ABO compatibility, HLA typing, cross-matching, and some degree of immune response testing for the proposed donor. Newer protocols using desensitization techniques have had some success in overcoming these immunologic barriers, such as a desensitization protocol for ABO incompatibility in living donor kidney transplantations.