Faculty Bibliography

The decreased survival of patients undergoing lung retransplantation has raised ethical concerns regarding the "fairness" of using organs for retransplantation. This emphasis on organ utility could have important consequences for the doctor-patient relationship and the practice of retransplantation. In an attempt to balance the responsibilities of individual physicians toward their patients and the responsibilities of transplantation programs toward the public resource of donated organs, we propose a limit on the percentage of organs used for experimental or innovative procedures such as retransplantation. This limit would allow the physician to function as the patient advocate, ensure that organs are realistically allocated to patients most likely to benefit from transplantation, and permit an evolving definition of the medical efficacy of retransplantation.

The escalation of health care costs in the United States has become a problem now that business and taxpayers are paying larger shares of these costs. Many believe that the only way to cope with rising costs is to institute explicit rationing of access to health care services. Proposals to ration based upon age, "sin" exclusions, physician gatekeeper incentives, patient ability to pay, and community values all have shortcomings. An alternative approach to controlling costs that emphasizes efficiency by cutting administrative and malpractice overhead costs and universally providing those medical services that have proven patient benefit is proposed. Physicians must take a more active role in the debate to ensure that patient needs are met and that expenditures are directed toward effective therapies.