Organ transplantation: historical perspective and current practice

Editor’s key points † There has always been a shortfall in numbers of suitable donor organs available for transplant. † Advances in immunosuppression have reduced the incidence of acute rejection but have not affected chronic immune damage. † Current research is directed at techniques to improve organ preservation. Summary. Over the course of the last century, organ transplantation has overcome major technical limitations to become the success it is today. The breakthroughs include developing techniques for vascular anastomoses, managing the immune response (initially by avoiding it with the use of identical twins and subsequently controlling it with chemical immunosuppressants), and devising preservation solutions that enable prolonged periods of ex vivo storage while preserving function. One challenge that has remained from the outset is to overcome the shortage of suitable donor organs. The results of organ transplantation continue to improve, both as a consequence of the above innovations and the improvements in peri- and postoperative management. This review describes some of the achievements and challenges of organ transplantation