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January 20, 1975

Dilemmas and Solutions

Author Affiliations

Rugosin Kidney Center New York

JAMA. 1975;231(3):245-246. doi:10.1001/jama.1975.03240150009004

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To the Editor.—  The thoughtful commentary "Dilemmas and Solutions" (230:401, 1974), by Harrison, contains an unfortunate and often repeated fallacy. The following is given as the second example of a moral dilemma: "Two persons need a kidney transplant in order to survive, but there is only one kidney available. How can the surgeon determine which candidate will undergo surgery?" Statistics reveal that mortality following transplantation is no better than after dialysis, and is often worse. An individual, therefore, does not "need a kidney transplant in order to survive." He does need a program of treatment for chronic renal disease that will include whatever type of therapy is best suited to his particular medical and social requirements.Institutional, self-care, and home dialysis are all viable treatment methods. Transplantation is an elective procedure, and should only be done in cases that have been fully evaluated by the transplant team for medical, surgical,