Renal transplantation (Tx) improves mortality and morbidity but is limited by availability of suitable organs. Clinical and economic impact of a Tx program for end-stage renal disease (ESRD) prisoners was evaluated. Wait list time and patient and organ survival rates were assessed. Twelve of the 104 ESRD prisoners at a prison dialysis unit were activated; 9 transplanted, 2 released active on the United Network for Organ Sharing list, and 1 died after listing. Kidneys from antibody-positive hepatitis C (HepC) donors were given to consenting HepC antibody-positive recipients. The average waiting period was 6.6 months for HepC-positive kidney recipients and 49.6 months for others. Compared with costs of continuing dialysis, Tx resulted in substantial savings. Patients with HepC experienced good graft and survival rates when given grafts from HepC donors, suggesting that transplantation is a viable, cost-effective option for the incarcerated patient with ESRD including those who have chronic HepC infection.

As the suicide rate for early adolescents has doubled in the past decade, pediatric liver transplant centers may more frequently encounter patients who present with acute liver failure secondary to an intentional ingestion of substances. The purpose of this article is to explore the ethical issues surrounding the determination of liver transplant candidacy for pediatric patients with suspected intentional ingestion of substances. Two case examples of pediatric patients who were evaluated for liver transplant after a suspected intentional ingestion of substances are explored. Evaluations to determine transplant candidacy in cases where an overdose is suspected, but unable to be confirmed, are typically complicated by time constraints due to medical urgency and potential biases by members of multidisciplinary transplant team members. More rigorous examination of long-term outcomes in pediatric patients who are post–liver transplant secondary to ingestion of substances is warranted. Until more robust pediatric outcome data are available, clinicians should continue to carefully weigh the risks and benefits of transplant while being guided by ethical principles. Pediatric psychologists working with potential liver transplant patients play a key role in ensuring that ethical principles are considered as a guide to inform transplant listing decisions.

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