Recommendations regarding issues facing organ transplantation.

M any previous presidential addresses of ASTS and the Transplantation Society have been concerned with various political and ethical issues facing the transplantation community and the public. My distinguished immediate predecessor stated last year in his Presidential Address that he had hoped to discuss the use of donor antigen to modulate allograft response, but he elected instead to delay this important immunologic topic to respond to the timely political and ethical issues facing transplantation. Perhaps we can look forward to the scientific topic as the subject of his next Presidential Address in Australia. Until a few weeks ago, I had planned to discuss the accumulating evidence that pancreas transplantation stabilizes and prevents some of the secondary complications of diabetes. However, I too have succumbed to the discussion of the pressing issues affecting transplantation currently. While some issues have been at least partially resolved, others have become more diverse and complex and await final solution. Many of these current problems would be simpler had we continued to perform the same number of renal and other organ transplants that were being performed a decade ago or even five years ago. Fortunate­ ly, for the patients and transplantation science, results have improved dramatically, and the volume of clinical transplantation has increased substantially. As a result, organ transplantation has been extended in a number of well-known centers to include at least two of the three other primarily vascularized organs— and, in a few institutions, all four organ transplants are being performed. With the increase in clinical organ transplantation, the continued short supply of organs has become one of the most vital issues facing transplantation today. The short supply is compounded by the fact that success rates have increased by approximately 30% for the kidney, liver, heart, and even the pancreas; this has rendered kidney trans­ plantation the best option for treatment of end-stage renal disease and has removed the other organs from experimental status. Several measures have already been undertaken to improve the supply of donor