What can be done about the insufficient supply of grafts?

Due to significant improvements in surgical techniques and immunosuppression, more and more kidneys but also nonrenal organs are transplanted. In order to meet this still increasing demand for organs in the future, optimal utilization of already existing resources by reduction of the wastage rate, multiple-organ procurement, and even dividing grafts is suggested. A real increase in graft supply may be achieved by creating a proper legal basis, recognition of brain death, and adoption of adequate forms of organization. In the light of the latest medical information, the justification of live donation has to be reconsidered. However, until enough organs from cadaveric donors are retrieved, kidneys may be taken from related living donors and in special situations from emotionally related persons. The concept of buying and selling organs has to be deplored for ethical reasons. The possibilities of xenografting will have to be evaluated in animal models by using modern immunosuppressive strategies.