In 1981, 814 cadaveric renal grafts were given to patients in the United Kingdom, a rate of 14.2 per million population. By 1989 the rate had more than doubled to 30.1 per million population, or 1728 cadaveric grafts. However, no further increase was recorded in the next three years, in which 1735, 1628, and 1640 cadaveric renal grafts were reported to the United Kingdom Transplant Support Service Authority. At the end of each of these three years the numbers of patients on the authority's waiting list for the United Kingdom were 3666, 3960, and 4361 - an average annual growth approaching 10%.1 For these patients who are waiting and for the transplant teams eager to help them the mood is approaching desperation.

Most organ donations come from patients on ventilatory support in intensive care units and in whom the criteria of brainstem death have been confirmed according to the rules laid down by the royal colleges.2 Such patients are the best source of cadaveric organs for transplantation, which are associated with a graft survival at one year of over …