It is generally agreed that the liberal retransplantation policies of the past can no longer be justified. The present challenge is to determine which patients should be offered retransplantation, and which should not. Some have proposed that the allocation system should direct all or most organs to primary transplant candidates based on the lower survival statistics of retransplant patients. This approach is clearly unfair as it fails to recognize the heterogeneity of retransplant patients in terms of expected outcome. Some non-physician bioethicists have suggested that allocation should not be determined on the basis of any special obligations that transplant teams might feel toward patients on whom they have already performed transplants — instead suggesting that they abandon those patients in their time of need. 14 They argue that health care workers cannot be expected to recognize when lifesaving methods should be curtailed, and that blinded by their role as patient advocates, the transplant team often makes poor decisions. Such a position denies the fact that such difficult decisions are faced throughout medicine and can only be made by the clinician at the bedside. Efforts to unduly restrict retransplantation would also negatively impact the field in general. For example, current efforts to expand the organ pool by the utilization of marginal donors

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