Transplantation--a new dimension for paediatrics.

Amazing advances have been achieved over the last 20 years in transplantation. As well as the problems of rejection and its control there are other difficulties which have to be confronted. There are shortages of donors, problems of selection for treatment and the problems of funding this expensive form of therapy. The need to make choices has to be considered and the criteria in determining choice have to be determined. Of particular concern in paediatrics are the problems that arise in relation to rehabilitation and the need to provide a multi-disciplinary approach to care. Finally, we have to remember that our enthusiasm for the possibilities of saving life and new treatments must not interfere with the basic responsibility to prevent suffering; at times the preservation of life at all costs is not justified, but in such circumstances doctors and other health care professionals have a responsibility for providing support both to the patient and to the family.