Three ways to improve the supply of cadaveric organs for transplantation

In every country that practises transplantation there is a growing gap between organ supply and demand. In the UK and Eire the waiting list for renal transplants rose from 4000 in 1991 to 5600 in 19971. Morgan2 concludes that the supply of organs might at least be maintained by improved identification and management in critical care units and better public knowledge of organ donation. From American sources it is calculated that, if all cadaveric organs could be retrieved, there would be sufficient to satisfy demand. Estimates vary between 28.5 and 56 cadaveric donors per million population3'4. In most European countries, the referral rate is static at around 15 donors per million population-enough for only a third of those on the waiting list-and the prevailing gloomy view is that we have reached a ceiling. In my opinion, however, three options for the UK have so far received too little attention.