Realizing the promise and managing the success of organ transplantation requires the creation of unique institutions. An Organ Procurement and Transplant Network (OPTN) must be capable of increasing the supply of cadaver donor organs, of allocating those organs properly to recipients with due consideration for equity and utility, and of using scientific data to improve the system for the good of society. The OPTN should answer to the public and should expect public support. Both in the United States and in Korea major changes in deceased donor organ procurement and allocation are in progress. In the United States change takes the form of a renewed emphasis on achieving equity in kidney allocation without significantly sacrificing transplant graft or patient survival and the first ever use of purely objective, statistically evaluated criteria for liver allocation. In Korea where the OPTN is only four years old, change takes the form of a new brain death law and the creation of that country's first organ procurement organizations. In both countries, success in meeting the transplant needs of their populations will ultimately depend on the support of society and the cooperation of the entire medical community.