Ethical dilemmas in organ donation and transplantation.

Since the first successful organ transplantation in 1953, we have seen an explosive development in transplantation surgery, particularly during the 1980s. With it followed an abundance of legal controversies and ethical dilemmas. Optimal use of viable organs necessitated precise definition of brain death in heart-beating cadavers with artificially maintained ventilation and circulation. Viable organs must remain well perfused to be suitable for procurement and transplantation into carefully selected recipients on an equal-opportunity basis. Due consideration must be given to both medical and social indications. At present, homografts dominate the field of organ transplantation; however, because of the shortage of human organs, both artificial organs (especially hearts) and xenografts are expected to become increasingly common in the near future. No doubt, the use of such modern technology will introduce additional ethical problems.