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Recent advances in medical technology and research have made possible an unprecedented level of health care for those living in economically advanced nations like the United States. Antibiotics, chemotherapy, functional imaging, telemedicine, reproductive technology, artificial organs, and transplantation are just a few of the weapons in our medical arsenal today that simply did not exist only fifty years ago. Not coincidentally, the field of bioethics has also grown over the same time span. Much of the concern about ethics is driven by the power of our new technological medical prowess.

Recent advances in medical technology and research have made possible an unprecedented level of health care for those living in economically advanced nations like the United States. Antibiotics, chemotherapy, functional imaging, telemedicine, reproductive technology, artificial organs, and transplantation are just a few of the weapons in our medical arsenal today that simply did not exist only fifty years ago. Not coincidentally, the field of bioethics has also grown over the same time span. Much of the concern about ethics is driven by the power of our new technological medical prowess.

However, technology need not be our master. If we think hard about the ethical implications of what a particular technology might permit us to do, if thinking about the ethical consequences of technological innovation becomes an essential part of research in biomedicine, and if we realize that as citizens and patients it is up to each of us to attend to the ethical and social ramifications of what biomedicine does to our lives, our pocketbooks, and our society, then we may be able to shape biomedical progress to best suit our values. Organ transplantation is one area where progress has been astounding but where ethical reflection has done a reasonably good job of keeping pace.

Ever since its inception in the 1950s, organ transplantation has been accompanied by many hard questions about the ethics of taking organs from the dead and the living and giving them to others. It has been one of the most fertile sources of discussion among physicians, ethicists, policy makers, and lay people. Some go so far as to claim that bioethics was born out of the attempt to treat organ failure with technologies such as kidney transplantation and renal dialysis.

Shortage has been a driving force behind the attention that the ethics of transplantation has received. The huge and frustrating shortage in the supply of transplantable organs and tissues for those who might benefit from them has prodded society to search for new sources of organs, new methods of procurement, new ways of managing dying, and innovative strategies for fairly distributing this scarce life-saving resource. Scarcity is an ever-present reality of transplantation so there is no avoiding tough questions about rationing, distribution, and what to do when someone must be told "no."

But scarcity is not the sole basis for interest in the ethics of organ transplantation. Even if the shortage of organs for transplant were somehow, miraculously, to disappear, there are still many other ethical questions that surround transplantation. Some argue that there is something wholly unnatural about taking a body part from one person and putting into another living human being. Despite the macabre aspect of using the dead to help the living, and the reality of using a tragedy for one person to help another, tens of thousands of transplantations are performed every year in the United States alone.

At first living and willing relatives were used as organ sources for transplantation, since there was no way to overcome biological differences between unrelated persons. But with the development of prednisone and later cyclosporin A came a huge increase in cadaveric grafts. As the success rate improved there was an increased demand for its benefits and for more transplant surgeons, centers, and programs. Organ shortages worsened and new sources began to be explored. Non-biologically related but emotionally related family members such as in-laws, altruistic not emotionally related donors such as friends, fetuses, anencephalic infants, patients in vegetative states, prisoners, and animals have all come under close ethical scrutiny for their "appropriateness" as donor sources. Within the coming years the transplant community may even find itself wrestling with the moral implications of cloning organs for transplant. In this section we discuss definitions of death and whether there are moral prohibitions or considerations that ethically compromise the use of certain potential sources, even in the face of profound organ shortages. . .

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