The future of organ transplant psychiatry depends less on immunologic and surgical advances than on 1) an increased supply of donor organs, 2) more sophisticated multicenter outcome studies, and 3) understanding of the subjective as well as objective aspects of compliance and quality of life for transplant recipients. From future studies, we may improve the selection process for candidates and discover which approaches are optimal for anxiety, depressive, organic mental, and personality disorders. Absolute contraindications to transplantation may become relative. Integration of ethical concerns with biomedical and psychosocial criteria for selection will challenge future investigators given the inadequate supply of donor organs.