Palliative care for patients with a failed liver transplant

The aim of liver transplantation is to cure the patient with acute or chronic liver disease. While this is often achieved, some patients will experience continued acute rejection of their transplanted liver (graft), established chronic rejection or disease recurrence. In these circumstances, it is necessary to re-assess the patient for treatment by re-transplantation but, with an increased mortality rate, the decision to proceed with this treatment must be carefully considered by the healthcare team, the patient and their family. For patients with diseases which are associated with a high risk of recurrence, quality of life as well as long-term prognosis are the principal aims of care. Integral to the decision to re-transplant is the ethical issue of allocating scarce organs where there is a reduced chance of graft and patient survival. The focus of the healthcare team in a liver transplant unit is commonly curative but, when caring for a patient with graft failure, the team must consider and, when appropriate, facilitate the palliative care approach.