Honoring 50 Years of Clinical Heart Transplantation in Circulation: In-Depth State-of-the-Art Review

Josef Stehlik, MD, MPH; Jon Kobashigawa, MD; Sharon A. Hunt, MD; Hermann Reichenspurner, MD, PhD; James K. Kirklin, MD


Circulation. 2018;137(1):71-87. 

In This Article

Organ Allocation

The early years of cardiac transplantation were challenged by the lack of a uniform definition of death that would allow ethically suitable procurement of donor organs. In 1968, a committee at Harvard University developed a formal definition of irreversible coma,[87] setting the stage for the development of uniform criteria for brain death, which would allow the procurement of living organs from a nonliving patient based on the determination of brain death. During the ensuing years, minor refinements of these criteria were used in the United States to establish the Uniform Determination of Death Act in 1980. With the knowledge that graft survival after cadaver renal transplantation was improved with a more closely genetically matched donor and recipient, organ sharing between regions began in the 1960s, eventually culminating in the establishment of the United Network of Organ Sharing (UNOS) in 1977. The National Organ Transplant Act of 1984 established a national organ procurement and distribution network for organ transplantation throughout the United States.