Solid organ transplantation, which began in adults in the 1950s, was extended to the pediatric population in the mid 1960s. Advances in immunosuppression and in surgical and medical skills have led to improving results in all types of organ transplantation. This success has now created many dilemmas especially in pediatric transplantation. In a field where the demands are high and resources limited, the distribution and allocation of resources becomes difficult. Complex decisions must be made with respect to who should be transplanted, when the transplant should occur, and where it should be performed. Of particular concern is the use of powerful immunosuppressive agents that may affect renal function and equally compromise patient's health with the potential for infection and malignancy. The various side effects of immunosuppressive agents may also cause difficulties in management. Decisions whether to retransplant habitual noncompliers are difficult. Diseases such as focal sclerosis and oxalosis, which recur in transplants, may affect decisions in selecting suitable recipients. The skills, experience, and resources of various multidisciplinary teams who manage these patients are often stretched to the utmost in their endeavors to achieve successful outcomes.
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