The dream of curing illness and injury by transplanting organs, bone, soft tissue and corneas is probably as old as the history of healing, but the scientific knowledge that has made modern transplant medicine possible dates back to the 19th and 20th centuries. Successful transplantation of bone, soft tissue and corneas came first, with many advances made between 1900 and 1920. The establishment of the U.S. Navy Tissue Bank in 1949 gave the nation its first bone and tissue processing and storage facility. By 1986, there were more than 300 nonprofit bone banks in operation, although consolidation has since decreased that number by almost half.

Progress in organ transplantation began in the 1950s. Dr. Joseph E. Murray, who received the Nobel Prize for Medicine in 1990, achieved the first successful kidney transplant in Boston in 1954. In 1967, a young South African heart surgeon named Christian Barnard became an international hero when he performed the first human heart transplant at Groote Schur Hospital in Cape Town.

Success in organ transplantation, however, was impeded by the tendency of the body's immune system to fight off "invasion" by any foreign element. It was not until 1978, when the immunosuppressive drug Cyclosporin was introduced, that this problem of rejection was largely overcome. Today, one-year survival rates for most recipients of transplanted organs are between 70% and 90%. Research continues to develop anti-rejection drugs which will reduce the side effects associated with Cyclosporin.

As transplant medicine accelerated, it produced a wealth of legal and ethical concerns, the most critical of which related to the determination of death. Technology had improved to the point where, in the 1960s, it became possible to diagnose death based on the ceasation of all brain function, a condition referred to as brain death. This determination is basic to organ donation which is possible only after brain death has been declared.

The first standard set of neurological criteria for determining death were drawn up at Harvard University in 1968 and 1969. These criteria have since been adopted by all 50 states, as has the Uniform Anatomical Gift Act which addresses the conditions governing organ donation. The National Transplant Act, passed by Congress in 1984, mandated many of the regulations safeguarding the donation process (outlawing the sale and purchase of human organs, for example) and set up a national waiting list for organ transplant patients. In 1986 the federal government amended the Social Security Act to require all hospitals receiving Medicare funds to notify the families of potential donors about their donation option. This is known as "Required Request".

In 1993 the Food and Drug Administration (FDA) initiated regulation of all U.S. Tissue Banks. Additional regulations were announced in 1997 including the registration of all tissue processors.

The rapid development of transplant medicine since the 1970s, combined with factors including general population growth and expansion of the elderly population, has caused an increase demand for donated tissues and organs. Today, it is estimated that approximately 500,000 Americans benefit from some form of transplant each year.

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