Futility and rationing in liver retransplantation: When and how can we say no?

Donor livers are a scarce, life-saving resource. For patients whose lives depend upon liver transplantation, the policies defining priority for donor livers are of ultimate importance. Fair and just utilization of available livers requires that policy makers understand how to balance the needs and interests of each of the stakeholders. Although significant medical and surgical advances have been made in the last three decades, many patients who undergo liver transplantation will eventually have early complications or recurrent liver disease resulting in failure of their transplanted liver graft.