Introduction

In less than 40 years organ transplantation has advanced from the experimental laboratory to clinical reality. As such, transplantation is now viewed as the treatment of choice for most forms of organ failure. The critical shortage of organ donors has resulted in the development of innovative surgical techniques, including reduced size organ partitioning, and a greater emphasis on living donation. Likewise, the public and legislators are being asked to consider novel approaches to organ donation such as Presumed Consent and financial incentives to organ donor families. The 1990s and the century beyond hold even greater promise for significant advances in our scientific knowledge and management of allograft rejection, immune tolerance, and cross-species transplantation. This chapter focuses on recent major advances in organ transplantation in the last decade and a better understanding of immunology introduced in clinical settings with new immunosuppressant agents that now challenge conventional protocols.

In addition, the concept of chimerism has invited new and exciting approaches to tolerance induction using bone marrow and stem cell-derived factors, combined with solid organ transplantation. Cell and intestinal transplants have also been initiated and will soon be included in routine clinical practice. Finally, the previously impossible feat of xenotransplantation has now been successfully carried out by the pivotal experiments in baboon to human liver transplants.

Special recognition for the exciting field of organ transplantation was recently awarded to Drs. Joseph Murray and E. Donnall Thomas, who received the 1990 Nobel Prize in Medicine for their visionary contributions to the fields of renal and bone marrow transplantation, respectively.