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would be impaired by the loss of the implicit safety net of retransplantation. A universal ban on retransplantation cannot be defended on ethical on practical grounds. The best approach at present is to work to improve the outcome of re-transplanted patients and to define the optimal situations in which retransplantation is appropriate. The use of statistical models to identify patients with unacceptably poor expected outcome has proven helpful - but must be applied with sound clinical judgment on a case-by-case basis.

References

Michler R., McLaughlin M., Chen J., Geimen R., Schenkel F., Smith C., Barr M., Rose E. Clinical Experience with Cardiac Retransplantation. J Thorac Cardiovasc Surg 1993; 106: 622-31.

Dein J., Oyer p., Stinson E., Starnes V., Shumway N. Cardiac Retransplantation in the Cyclosporine Era. Ann Thorac Surg 1989; 48: 350-5. The Registry of the International Society for Heart and Lung Transplantation. Srivastava R., Keck B., Bennett L., Hosenpud JD. The Results of Cardiac Retransplantation: An Analysis of the Joint International Society for Heart and Lung Transplantation/United Network for Organ Sharing Thoracic Registry. Transplantation 2000; 70(4): 606-612.

Ranjit J., Chen J., et al. Long-term Survival After Cardiac Retransplantation: A Twenty-Year Single-Center Experience. The Journal of Thoracic and Cardiovascular Surgery 1999; 117 (3): 543-55.

Novick R., Stitt L., Al-Kattan K., Klepetko W., Schafers H., Duchatelle J., Khaghani A., Hardesty R., Patterson G., Yacoub M. Pulmonary Retransplantation: Predictors of Graft Function and Survival in 230 Patients. Ann Thorac Surg 1998; 65: 227-34. Novick R., StittL., Schafers H., Andreassian B., Duchatelle J., Klepetko W., Hardesty R., Frost A. Pulmonary Retransplantation: Does the Indication for Operation Influence Postoperative Lung Function? J Thorac Cardovasc Surg 1996; 112: 1504-14. Shaw B., Gordon R., Iwatsuki S., Starzl T. Retransplantation of the Liver. Seminars in Liver Disease 1985; 5: 394-401.

Velidedeoglu E, Desai NM, Campos L, et al. The outcome of liver grafts procured from hepatitis C-positive donors. Transplantation 2002; 73: 582. Markmann J., Markowitz J., Yersiz H., Morrisey M., Farmer D., Farmer D., Goss J., Ghobrial R., McDiarmid S., Stribling R., Martin P., Goldstein L., Seu P., Shackleton C., Busuttil R. Long-term Survival After Retransplantation of the Liver. Annals of Surgery 1997; 226: 408-20.

Doyle H., Morelli F., McMichael J., Doria C., Aldrighetti L., Starzl T., Marino I. Hepatic Retransplantation - An Analyis of Risk Factors Associated With Outcome. Transplantation 1996; 61: 1499-1505.

Markmann J., Gornbein J., Markowitz J., Levy M., Klintmalm G., Yersiz H., Morrisey M., Drazan K., Farmer D., Ghobrial M., Goss J., Seu P., Martin P., Goldstein L., Busuttil R. A Simple Model to Estimate Survival Following Retransplantation of the Liver. Transplantation 1999; 67: 422.

Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PCJ. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000; 31: 864

Ubel P., Arnold R., Caplan A. Rationing Failure - The Ethical Lessons of the Retransplantation of Scarce Vital Organs. JAMA 1993; 270: 2469-2474.

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