During the last 29 years the dramatic changes that have taken place in our transplant programs and in solid organ transplantation permit us to face tomorrow with courage and confidence. In the future we will be deeply concerned that the long-term benefit of more effective immunosuppression or novel strategies might be unfavorably impacted by the tendency to use organs whose intrinsic lifespan may be limited. We are deeply concerned by the inexorably increasing discrepancy between supply and demand for deceased kidneys, especially for the added morbidity that this inevitably entails for those patients with ESRD who do not have live donors. Our program continues to seek better ways to improve survival and the quality of the life of our patient population.