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July 28, 1975

Adequacy of Dialysis

JAMA. 1975;233(4):357. doi:10.1001/jama.1975.03260040051027

Cost/benefit considerations often enter into the making of many therapeutic decisions. Sometimes when the alternative to benefit is certain death, the decision is simplified. The public or private sector of our humane society will assist the threatened individual. Life must be preserved at all costs. But, even in desperate situations, cost becomes an important decisional factor, if a choice exists between two or more life-sustaining measures. Decisions then have to be made on the basis of comparative cost, and this is no simple matter, as is well illustrated in the treatment of renal failure.

Hemodialysis and renal transplantation often compete for priority of choice in advanced renal failure. Each of these two treatment modalities carries its own complex of costs and benefits. The benefits of renal transplantation are obvious. Patients with successfully grafted kidneys do not depend on a machine—a psychological bonus of no small moment. They have greater freedom