Long considered as an irrealistic option, organ transplantation has emerged, over the last two decades, as a genuine clinical service. Medical and economical benefits are now well documented. Starting with kidney, the pathfinder organ, then followed by liver, heart, pancreas, transplants are now performed in hundreds of medical institutions around the world.
The seminal contributions of Dr Starzl’ team in Denver and Pittsburgh, and of Dr Najarian and Sutherland at University of Minnesota in the establishment of multi-organ transplant centers must be emphasized. The rationale of this approach is the observation that, from organ procurement down to transplant follow-up, the same ethical, medical, scientific, practical and logistical tools and competencies are required, independently of the type of engrafted organ. In addition, the surgical procedure itself is always disturbing for any non-dedicated facility, since it is difficult -if not impossible- to plan it as part of an elective schedule. For the patient, the « one site setting » concept, including a 24/7/52 « call center » minimizes the stress, anxiety and disturbances of a geographically scattered activity. From a psychological point of vue, a dedicated and friendy nursing and medical team will at best restore or preserve confidence and calmness. Finally, economical issues are under more efficient control, through increased experience and economy of scale.
Following this strategy, we started from scratch a multi-organ program at University Louis Pasteur (ULP) medical school in Strasbourg, France as of 1987. It does include 2 operating rooms, 18 hospitalization beds, an outpatient facility (40 consultations a day) and a research lab. We transplant kidneys, livers and pancreases having performed respectively 1300+, 1050+ and 90+ cases, with an average of 150 cases /year.
Facing the issue of the structural shortage of organs, we found that optimization of the follow-up was part of the answer to this problem. Our experience is presented with emphasis on pros and cons of our approach, versus mono-organ activity.