Pilot bushing (left) or pilot bearing (right)...
This little guy presses into the end of the crankshaft. The input shaft of the gearbox has a small nub on the end of it, that plugs into this bushing. The bushing is made from soft bronze and they tend to get wollered out over time. This can cause some mis-alignment and "chatter" when releasing the clutch pedal. If your truck vibrates or shudders during slow-release uphill take-offs...this could be the issue. I always replace them with a roller bearing like the one on the right but, there are probably a million opinions on which is better. The roller-type uses hardened steel needle bearings and there is minimal friction, unlike the bronze bushing. The bushing-types wear slowly over time, so they need replacing more often. You can test for wear by inspecting the hole in the center. Most of the time, they will be egg-shaped. You can also use a clutch alignment tool (needed to install your pressure plate/disc kit) to check for excessive slop. I actually use an old input shaft from a Muncie for this. The bearing-type doesn't wear much at all, however they can seize and/or run dry and when they do...they're toast (like Mr_Rich noted). I've re-used the bearing types several times and all I do is add a blob of grease. Regardless...either type needs a pea-sized blob of high-temp grease during installation.
Sometimes you can pull them out of the crank by hand (they should never be this loose). But, most of the time you need a special pilot bushing puller tool...

To install the new one, simply tap it into place with a dead-blow or small brass hammer.
You don't always need a new pilot bushing/bearing. Its just something you should be aware of and always check. A worn pilot will eat your new clutch, and it also contributes to input shaft bearing wear inside the gearbox. Its a small, inexpensive part that plays a big roll in clutch engagement...and its buried inside a 4-5 hour job. So, it really is worth your effort to check and replace it if you have any doubts.