Cardiac retransplantation: determining limits.

OBJECTIVE

Cardiac transplantation has become an acceptable treatment option for end-stage congestive heart failure. Because of the increasing demand, there are not enough hearts to supply all patients in need of cardiac transplantation. This significant supply and demand imbalance necessitates that rationing decisions be made. This article will explore decisions made surrounding cardiac retransplantation.

CONCLUSIONS

Early statistics suggest that survival for patients undergoing retransplantation is lower than first-time transplant recipients. In addition, the question of justice or fairness arises. Patients who are offered second and third heart transplants may deprive a significant number of patients who have not had their first chance at transplantation. The authors propose, based on medical suitability, respect for autonomy, and the principle of justice, that cardiac transplantation be a one-time treatment option. Retransplantation should not be allowed.