card and a red ''donor" sticker at application for a driver's license (L. Futral, personal communication, September 17, 1997). The nationally active Coalition on Donation has generated more than $30 million in donated media time and space in the few years since it was established and, with bipartisan congressional support, generated donor cards that were inserted in 70 million income tax refunds in 1997. A new organization, the Redford Institute for Transplant Awareness, using its access to the media and the entertainment industry, is also beginning campaigns.

Current levels of effort including recent positive developments may have a significant effect and, along with further efforts, should be vigorously followed up. Alone, however, they seem unlikely to provide multiple marginal improvements of the magnitude necessary to resolve the demand crisis. The number of variables and the lack of quantitative information that have been cited preclude any certainty about supply and demand. Real demand seems likely to be many times the supply possible with current scenarios. Therefore, transplant programs are being challenged, particularly since the Pittsburgh protocol in 1992 (Arnold, 1995; DeVita and Snyder, 1993), to explore whether a new category of donor, the non-heart-beating donor, might add significantly to supply, although this kind of donor is more a refinement of one of the earliest categories that had fallen into relative disuse than a new concept.

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