introduction

The number of kidney transplants has declined 3 years in a row, despite growth in the number of new patients added to the deceased donor kidney waiting list, both active and total (active plus inactive). The reasons for this worrisome trend are unknown, and they represent an ongoing source of controversy. This is particularly true given the relatively high rate at which kidneys removed for the purpose of transplant are discarded. Even more dramatic has been the decline in pancreas transplants, which has occurred despite an adequate source of deceased donor pancreata. This could reflect better alternative treatments for diabetes or other factors leading to less demand. The most rapid change in solid organ transplantation has been in heart and lung transplants.