Guidelines for the referral and management of patients eligible for solid organ transplantation

Members of the Clinical Practice Committee, American Society of Transplanta tion, have attempted to define referral criteria for solid organ transplant ation. Work done by the Clinical Practice Committee does not represent the official position of the American Society of Transplantation. Recipients fo r solid organ transplantation are growing in numbers, progressively outstri pping the availability of organ donors. As there may be discrepancies in re ferral practice and, therefore, inequity may exist in terms of access to tr ansplantation, there needs to be uniformity about who should be referred to transplant centers so the system is fair for all patients. A review of the literature that is both generic and organ specific has been conducted so r eferring physicians can understand the criteria that make the patient a sui table potential transplant candidate, The psychosocial milieu that needs to be addressed is part of the transplant evaluation. Early intervention and evaluation appear to play a positive role in maximizing quality of life for the transplant recipient. There is evidence, especially in nephrology, tha t the majority of patients with progressive failure are referred to transpl ant centers at a late stage of disease, Evidence-based medicine forms the b asis for medical decision-making about accepting the patient as a transplan t candidate. The exact criteria for each organ are detailed, These guidelin es reflect consensus opinions, synthesized by the authors after extensive l iterature review and reflecting the experience at their major transplant ce nters. These guidelines can be distributed by transplant centers to referri ng physicians, to aid them in understanding who is potentially an acceptabl e candidate for transplantation. The more familiar physicians are with the exact criteria for specific organ transplantation, the more likely they are to refer patients at an appropriate stage. Individual transplant centers w ill make final decisions on acceptability for transplantation based on spec ific patient factors, It is hoped that this overview will assist insurers/p ayers in reimbursing transplant centers for solid organ transplantation, ba sed on criteria for acceptability by the transplant community. The selectio n and management of patients with end-stage organ failure are constantly ch anging, and future advances may make obsolete some of the criteria mentione d in the guidelines. Most importantly, these are intended to be guidelines, not rules.