Policy and Practice in Organ Transplantation

Franki Chabalewski, RN, MS; Gloria J. Taylor, RN, MA, CPTC; Kim Johnson, MS; Katherine A. Evers, RN, BSN, CCRN, CPTC; Lin Johnson McGaw, RN, MEd; Deanna C. Sampson, JD; Joel Newman, MS


June 17, 2002


Within the relatively short time span of 50 years, the science and practice of organ and tissue transplantation has evolved from a mode of experimental surgery to a legitimate, life-saving treatment modality for patients with end-stage organ disease. Advances in medicine, technology, and pharmacology have consistently fueled this evolution, and today, tens of thousands of people are given the hope of survival through this extraordinary surgical treatment.

Following the first successful kidney transplantation from 1 identical twin to another in 1954, advances in immunology became the single most important factor in promoting the advancement of transplantation with the use of cadaver organs during the 1960s. Although Bichat defined brain death as early as 1800, it was not until 1959 that the French neurophysiologists Wertheimer, Jouvet, and Mollaret published studies describing this clinical state, for which they coined the term "coma dépassé" (irreversible coma), and set the foundation for our present method for legal determination of brain death.[1] It was the combination of these 2 medical advances, immunosuppression and the recognition of brain death as a legal means of pronouncing death, that increased the demand and prompted the current critical shortage of organs available for transplantation.

The objectives of this chapter are to:

  • Summarize the historical development of organ donation

  • Describe the organizational framework for organ procurement, donation, and transplantation

  • List key legislative and regulatory initiatives that have contributed to the present status of organ procurement and donation

  • Define the role of the Organ Procurement Transplant Network

  • Explain the key roles of the United Network for Organ Sharing (UNOS) in donation and transplantation

  • Summarize efforts to increase organ donation.