Nephrology and Bioethics

Nephrology has been the battleground for some of the most bruising disputations ascribable to ethical ambiguities. Renal transplantation, for example, had to face the almost absurd question of who was dead—and thus eligible to be an organ donor—and who was not. Peace was declared only when death was redefined as brain death. We remember vividly the selection of patients who would receive dialysis at a time when there were few such facilities. Candidates were chosen by life-or-death committees until nephrologists rejected the concept of making such choices. The result was federal support of dialysis so that all might have access to it. Even this solution eventually brought back the original problem: the number of patients receiving dialysis treatment increased so rapidly that we again hear competing claims for limited resources. Thus, while problem solving is a pleasurable activity, one is soon confronted with new problems or exacerbations of old ones.