Ethical considerations in lung retransplantation

The decreased survival of patients undergoing lung retransplantation has raised ethical concerns regarding the "fairness" of using organs for retransplantation. This emphasis on organ utility could have important consequences for the doctor-patient relationship and the practice of retransplantation. In an attempt to balance the responsibilities of individual physicians toward their patients and the responsibilities of transplantation programs toward the public resource of donated organs, we propose a limit on the percentage of organs used for experimental or innovative procedures such as retransplantation. This limit would allow the physician to function as the patient advocate, ensure that organs are realistically allocated to patients most likely to benefit from transplantation, and permit an evolving definition of the medical efficacy of retransplantation.