waiting list if their condition changes (this could be either an improvement or a deterioration) to the point that they no longer meet the eligibility criteria outlined in this document. While there are specific recipient inclusion and exclusion criteria for each organ, there are general conditions that apply across all organs. These are: Age: with the increasing success of transplantation, the age range considered suitable for transplantation has steadily increased. Age is not by itself an exclusion criterion for most organs. However, the presence of multiple comorbidities in patients over 70 years of age is likely to exclude the majority of such patients from eligibility for transplantation.1,2 April 2021 version 1.5 2 Comorbidities: exclusion criteria generally include conditions or combinations of conditions that would result in an unacceptably high risk of mortality or morbidity during or after transplantation (e.g. active malignancy, severe cardiac disease, or chronic infection). Behavioural risk factors: the fact that an individual may require a transplant due to lifestyle choices they have made in the past is ethically irrelevant. However, ongoing substance abuse—including excessive alcohol consumption, cigarette smoking and illicit drug use—are generally considered contraindications to transplantation. These lifestyle factors increase the risk of poor transplant outcomes.3-7 Inability to adhere with complex medical therapy: for example chronic cognitive or neuropsychiatric deficits in the absence of a carer capable of facilitating adherence to therapy. 8-12 All patients assessed for eligibility for transplantation have the right to know whether or not they have been placed on the transplant waiting list, and the reasons why they have not been listed if they are deemed ineligible. Recognised transplant units in Australia and New Zealand are listed in Appendix H. 1.2.2 International patients TSANZ supports the Declaration of Istanbul on organ trafficking and transplant tourism.13,14 In view of the existing gap between the need for donor organs and their availability, TSANZ considers it inappropriate for international patients (non-citizens and non-permanent residents of Australia and New Zealand) to be assessed for transplantation except under exceptional circumstances. An example of such exceptional circumstances might be when an international visitor develops acute organ failure that would normally warrant consideration for transplantation and is too unwell to return to their home country. In this situation it needs to be established that the visitor will return to a jurisdiction where appropriate post-transplant follow-up and ongoing treatment will be provided. International patients may receive an organ transplanted from a living donor at an Australian hospital, provided the usual criteria for living donor transplantation have been met and associated financial implications have been addressed and agreed upon by the recipient and the hospital. 1.3 Consent Consent is defined in the Ethical Guidelines as a person’s or a group’s agreement, based on adequate knowledge and understanding of relevant material.15 As for all medical procedures, consent should be given before transplantation can proceed. If the individual does not have the capacity to give consent or is a minor, a representative should be involved in ongoing discussions and decision-making. Sufficient information about the procedure must be made available, including the risks, the benefits, and what will happen if the procedure does not go ahead. The acceptability of donor organs that may pose an element of risk to the recipient should be discussed with both the potential recipient and their carer at the time of wait-listing (rather than at the time of the organ offer). With the introduction of new and safe antiviral therapy for Hepatitis C virus (HCV) infection this should include the possible use of an organ from a HCV infected donor into a recipient without HCV infection. The provision of adequate counselling and education is critical to the potential recipient’s ability to consider their options and ultimately provide informed consent if they choose to proceed with transplantation in these circumstances. It is imperative that the potential recipient receives comprehensive education regarding the transplant procedure and its potential short- and long-term outcomes. All patients are not equal in terms of their capacity to understand this information, and it is the clinician’s role to ensure that information is provided at a level that is comprehensible to the patient. This should be done before surgery—ideally during the assessment phase—and over a series of meetings including consultations with clinicians and patient education sessions, with provision of supplementary reading material and/or electronic media. Provision of written consent specific to the planned transplant must be sought. Provision of written consent should be preceded by discussion(s) of immunological and surgical risks, plus explicit discussion of any case- April 2021 version 1.5 3 specific risks related to donor quality or risk of donor-derived disease (e.g. in the case of a tumorectomised kidney and cancer risk, or a hepatitis B core antibody positive donor or, more recently, the use of HCV positive organs in HCV negative transplant recipients – see Chapter 2) without compromising donor anonymity. In the case of children, both the