The introduction of immunosuppression with cyclosporine A in 1983 compared to conventional immunosuppression has clearly improved early results within the first year post transplant. In contrast, the rate of graft failure per year in the following course has not changed essentially. Still HLA histocompatibility is a predominant prognostic factor which can be influenced by organ sharing. On the other hand, donor factors like sex and age are becoming more important and should be taken into account for organ allocation. This furthermore requires strict attention to future exchange rules within the transplant community.