With medical advances transplantation has become a common approach to treating an increasing number of end stage organ failure disorders. Kidney, heart, liver and bone marrow transplantation are being performed in many countries at an increasing rate largely limited by the availability of organs (United Network for Organ Sharing [UNOS], 2001). In addition, significant progress has been made in transplantation procedures involving pancreas, lung, cornea, skin and islet cells. Simultaneous multiple organ transplantation is advocated as the treatment of choice for patients with multiple organ failure (Schweitzer et al., 1997) (see, for example, ‘Coronary heart disease: heart failure’). Transplantation of external body parts such as hands (e.g. Klapheke et al., 2000) and transplants from animals (e.g. White & Nicholson, 1999) are driving transplantation research and practice into new territories.

Progress in surgical techniques, organ preservation and improved methods to decrease graft rejection, including advances in histocompatibility testing and immunosuppression have resulted in unprecedented graft and patient survival rates (Niklason & Langer, 2001). For example, today 88% of patients receiving a kidney, 77% of patients received a heart and 80% of patients receiving a liver will have a functioning graft one year after the operation (British Transplantation Society [BTS], 2003).

Despite the rapid proliferation in the number of transplant programmes and the number of transplant candidates worldwide, the number of organ donors has remained relatively stable. Most organs come from cadaver donors, with head trauma and cerebral vascular accidents being the cause of death in 85% of cadaver donors (UNOS, 2001).