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The algorithm for the allocation of donor hearts used by the United Network for Organ Sharing (UNOS) was changed in January 1999. The new scheme alters the medical urgency criteria from a 2-tiered to a 3-tiered system. Blood type O and blood type B candidates are less disadvantaged and pediatric candidates are somewhat advantaged with regard to adolescent donors. The new allocation algorithm allows an individual with life-threatening ventricular arrhythmias to be listed in the highest urgency status. Increased regulation will occur with the establishment of a review for the highest urgency status and the establishment of regional review boards.

Few other public policy debates involve the sensitive personal decisions that surround organ and tissue donation for transplants or medical research, or cover issues ranging from drivers' licenses and eye banks to informed consent for anatomical gifts.

The incidence of chronic renal failure in China is approximately 120,000 cases per year; the vast majority of these new cases will die within a very short time because of the shortage of funds, dialysis machines, and organs for transplantation. This paper focuses on the reasons behind the organ shortage and the strategies proposed by the Chinese medical profession to increase the supply of transplantable kidneys. The data were gathered on multiple trips to China, Hong Kong and Taiwan between August 1993 and January 1995. During these trips the author spoke formally with nephrologists, urologists, dialysis and transplant nurses, and other individuals active in the field of organ procurement, and informally with others familiar with general hospital practice. The author also draws heavily on articles published in leading Chinese journals. The kidney shortage in China is produced by the same sorts of problems as exist in other countries, but the shortage is aggravated by certain beliefs and practices specific to Chinese populations. Live donation is hampered by traditional beliefs about the function of the kidney, while cadaver donation is hampered by reluctance to cut a body and a host of beliefs about ghosts, labeled "feudal superstitions" by the authorities. Cadaver donation is further restrained by the lack of legal recognition of "brain death". In response to the organ shortage, the Chinese medical community has expanded the range of eligible sources to include those condemned to death as criminals, a practice itself usually condemned by the wider international community. At the same time it has advocated: (1) enhancing corpse donation through propaganda work, administrative work, legal work, and incentives; (2) encouraging live donation; (3) familiarizing the public with the benefits of organ transplantation, and (4) pursuing the development of artificial organs.

From trephination to modern surgical procedures, transplantation is an exciting technology that has evolved over centuries. This article reviews the historical incidences of organ and tissue transplantation among humans and reflects on accomplishments made in general surgery that assisted transplant technology. Following a brief historical overview, the article focuses on modern transplanting issues including: development of immunosuppressive therapy, organ availability, qualifications for donors and recipients, organ procurement, and new transplant technology.

In the United States, standards for cell and tissue processing have been developed by a variety of professional tissue banking organizations. Several organizations, including the American Association of Tissue Banks and the Eye Bank Association of America, have accreditation programs for member institutions. Some governmental agencies, such as the New York State Department of Health and the Food and Drug Administration, have adopted strict regulations, which may subject noncompliant tissue banks to certain enforcement actions. Professional tissue banking organizations have also issued guidelines that provide recommendations for implementing efficacious policies and procedures for the acquisition, processing, storage, and distribution of tissues.

Extraordinary advances in science and medicine such as transplantation of human tissues not only bring about previously unimaginable societal benefits but also create profound implications that involve autonomy and belonging, opposing moral considerations, and legal concerns. Today, technology is changing faster than our values. The issue of salvaging organs from the dead to meet the escalating need for human organs for lifesaving organ transplantation has evolved into an intricate web of interdisciplinary concerns and value conflicts; right and wrong are opinions and consensus does not seem to exist. This organ supply-demand mismatch, as well as suggestions for its resolution, has become a major challenge to the transplant community and to those in political and bioethical arenas. A methodical transition to presumed consent, or opting-out legislation, which removes the burden of decision from the family and the burden of request from the healthcare professional, may be the only solution to correct the imbalance between human organ need and availability.

When successful solid organ transplantation was initiated almost 40 years ago, its current success rate was not anticipated. But continuous efforts were undertaken to overcome the two major obstacles to success: injury caused by interrupting nutrient supply to the organ and rejection of the implanted organ by normal host defense mechanisms. Solutions have resulted from technologic medical advances, but also from using organs from different sources. Each potential solution has raised ethical concerns and has variably resulted in societal acclaim, censure, and apathy. Transplant surgery is now well accepted, and the list of transplant candidates has grown far quicker than the availability of organs. More than 30,000 patients were awaiting organs for transplantation at the end of March 1993. While most organs came from donors declared dead by brain criteria, the increasing shortage of donated organs has prompted a reexamination of prior restrictions of donor groups. Recently, organ procurement from donors with cardiac death has been reintroduced in the United States. This practice has been mostly abandoned by the U.S. and some, though not all, other countries. Transplantation has been more successful using organs procured from heart-beating, "brain dead" cadavers than organs from non-heart-beating cadavers. However, recent advances have led to success rates with organs from non-heart-beating donors that may portend large increases in organ donation and procurement from this source.

The condition of newborn infants with anencephaly, a neural tube defect, is incurable and uniformly fatal. Although physicians reached a consensus two decades ago on the appropriateness of using these infants' organs, ethical and legal questioning has since challenged the grounds on which medical authorities justified transplantation. Advocates have proposed three conceptual strategies to warrant procuring anencephalics' organs: redefining death, excluding the infants from possessing personhood, and intubating and ventilating them while keeping a vigil for brain death. Each of these conceptual schemes has arguable shortcomings in its construction, however; as such, the case for using anencephalic infants as sources of organs has yet to be conclusively demonstrated.

The first kidney transplant in Scandinavia was performed in 1956 by the late Professor Leif Efskind in Oslo, Norway. During the following 7-year period he did another four necro-kidney transplants. The first living related kidney transplant was performed at Ullevål Hospital in Oslo in 1963. In 1964 kidney transplantation programs were started in Helsinki, Stockholm and Aarhus, followed by Gothenburg in 1965. By the end of 1970 programs had also started in Copenhagen, Uppsala, Lund/Malmö and Odense. At present, there are 10 kidney transplant centers in Scandinavia: four in Denmark, four in Sweden, and one each in Finland and Norway. By the end of 1968 a total of 358 kidney transplants had been performed in Scandinavia. Of these, 169 (47%) were from living related donors. This new treatment modality called for closer cooperation between the Nordic countries, and during the last 20 years cooperation has been broadened through two working bodies: an expert committee and the Scandiatransplant organization.