Technological advances mean more people should be able to benefit from organ transplants, but a lack of raw material - in the form of organs and staff - is hindering progress.

A report by the Royal College of Surgeons says the shortage of organs and specialists has pushed the service into crisis.

It states that the number of patients requiring a transplant operation grew by 3.3% between 1996 and 1997.

The upwards trend is expected to continue with the spectrum of patients getting transplants widening.

For example, more and more children are receiving new organs - almost 300 had transplant operations in 1997.

But there are not enough organs to go around.

Despite improvements in retrieving multiple organs from dead donors, the number of dead donors has remained stable.

This is due to a fall in fatal road accidents - down from an average of 5,794 a year in the early 80s to 3,740 in 1996.

At the same time, however, there has been an increase in using live donors for operations such as kidney and single lung transplants.

But this is not enough to meet growing demand, particularly in the field of kidney transplants.

The need for kidney operations is expected to rise by 30% in the next few years.

This is partly because transplants are now the preferred treatment for people with end-stage kidney disease and are more cost effective than dialysis.

Demand is also growing for liver and lung transplants and there is a shortage of hearts for transplants.

Older donors

Due to the shortage and technological advances, there has been a rise in the use of older live donors.

77-year-old Doug Gibson is believed to be Britain's oldest living donor

In 1997, there were 64 kidney donors aged 65 and over, compared with 12 in 1988.

The average age of donors was 34 in 1988 and is now around 40.

Another big problem is a shortage of transplant specialists, particularly in the kidney field.

There are only 67 consultant renal transplant surgeons in the UK. The RCS says 88 are needed just to deal with current demand.

Part of the problem is that trainee specialists are increasingly opting out of a career in kidney transplantation because of the high emergency workload and anti-social hours the job involves.

A 1996 survey showed 40% of trainees did not end up as kidney transplant specialists.

Experts do not believe creating more renal units is the answer to the crisis.

They say many of the smaller renal units should be closed because they do not perform enough transplants to be accredited for training.

Staffing shortages

Pancreas transplants, performed on people with insulin-dependent diabetes, are carried out by renal transplant units so face the same staffing shortages.

In 1997, there were 61 patients on the waiting list for kidney and pancreas transplants. Four were waiting just for pancreas transplants.

There are also staff shortages in the liver transplant field. Three of the UK's seven liver units report recruitment problems.

The number of liver transplants being performed in Britain almost doubled between 1990 and 1995.

A kidney transplant is cheaper than ongoing dialysis

This was partly due to an increase in splitting livers and implanting them in two patients and in retrieving livers from multi-donors.

But since 1995, the number of transplants has remained level.

Heart, heart and lung and lung transplants offer a more satisfying career for specialists, says the RCS report.

This is because surgeons deal with a wide range of cases.

But the downside is that they often have to work at night because, once a heart is removed, it ideally has to be implanted within four hours.