Organ donation.

Liver transplantation expertise has expanded throughout the world to the point where liver transplants are available in most developed countries. In many cases, however, legislation and regulations have not kept pace with the advances in healthcare technology. In a few cases, these regulatory voids have lead to exploitation and profit making around transplantation activities. The growing patient demand has motivated governments to develop numerous national efforts to improve the standards by which organ donation and transplantation are practiced and programs to increase the number organ of donors, most notably in Spain. Although these efforts have helped, the worldwide demand for lifesaving transplantation exerts extreme pressures such that financial incentives, profit making, and overt exploitation have compelled the World Health Organization to issue guiding principles. Other efforts to increase the number of available organs have centered on expanding the medical criteria for acceptable organ donors and using donation after cardiac death protocols. Implicit in these efforts is the need to understand, both on the part of the practitioner and the recipient, the higher risks involved in using these donors, the circumstances in which taking such risks are justified, and that all parties-including those responsible for paying the higher healthcare costs associated with using these organs-are willing to assume these risks. Also important is recognizing that the risks of transmission of donor disease to recipients are very low but not zero, even though these events receive enormous media attention. As the demand for organs rises relentlessly, more research must be devoted to understanding how to make the marginal donor organs function better.