The National Organ Transplant Act (PL98-507) was enacted in 1984 to support the continued development of a comprehensive procurement and distribution network in the United States for transplantable organs and tissues as well as a registry for potential recipients. Demand for one organ, the kidney, has increased dramatically for a number of desirable reasons: More patients have been accepted for transplantation, age limits for transplantation have been extended, results have improved, and there are more transplantation centers doing more transplants. Undesirable factors have also increased the demand: There has been no major breakthrough in treatment of the renal diseases that most frequently progress to end-stage failure, and graft rejection continues to be a problem. On the other hand, the supply of cadaver kidneys has decreased: Fortunately, the number of fatal motor vehicle accidents has fallen because of the lowered highway speed limit and seat belt use, but, unfortunately, public misconceptions about transplants, lawsuits against physicians participating in cadaver organ retrieval, and gaps in professional understanding have also decreased the supply. Although rejection can be treated with immunosuppression after transplantation, histocompatibility matching of donor and recipient before transplantation has significantly increased graft survival. The national initiative may provide the critical mass necessary to correct some of the misconceptions and lingering problems that frustrate the optimal use and success of human organ transplants.