How Many Hearts Should One Child Receive?

Art Caplan´s statement adds another important contribution to the ongoing discussion about how to distribute a scarce resource - donor organs - among the large number of patients on the respective waiting list. How many re-transplantations can we or should we accept and - is the (limited) outcome after a first or second re-transplantation the same, no matter if caused by an acute rejection or an acutely failing organ (heart)? And - don´t we get into a vicious circle in that donor organ shortage leads to a more liberal acceptance of organs more prone to early failure? Are the sickest patients on a waiting list really the best candidates for first priority? As a devil´s advocate, there might be many more such questions to be posed.. At the end, this only shows, how important a multidisciplinary discussion of all these issues is and how necessary generally accepted guidelines, implemented by such an expert panel, are. However there will also still be a need for individual decissions in such cases as the one reported by Dr. Caplan and accordingly the need for experienced and resposible doctors.