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• Clash of Cultures: Nephrologists Meet the Market Economy (PDF 2pgs) William M. Bennett, MD Medical Director Organ & Cellular Transplanttation, Legacy Good Samaritan Hospital, Portland, OR	• Cost-effectiveness of extending Medicare coverage of immunosuppressive medications to the life of a kidney transplant (PDF-28 pgs)
• Ethical Conflicts for Physicians Treating ESRD (KIDNEY FAILURE) Patients (PDF-5 pgs) William M. Bennett, MD Northwest Renal Clinic	• Chicago Tribune article: (weblink) Treatment Disparities Between Blacks And Whites With Kidney Failure
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Thomas Starzl, MD
Transplant. Pioneer, Often called “The Father of Transplant”
University of Pittsburgh

Printed with Permission
Dr. Starzl wrote in his autobiography THE PUZZLE PEOPLE:

“The economic plight of patients and their families was relieved in 1973 by the federally mandated End-State-Renal Disease (ESRD) program. The new system originated in the 1972 with an amendment to the Social Security Act. It was one of the most noble examples of health care legislation in history… The legislation created overnight a national network for the care of patients with kidney failure. The government would pay the bill for both dialysis and transplantation.

At the same moment, the federal flow of gold created a potential economic aristocracy of medical kidney specialists who provided artificial kidney services (dialysis) and a disincentive for transplantation. In Denver, for example,…a dozen private facilities sprang up overnight. There were too many centers to be profitable if their patient ranks were thinned by systematic removal of patients for transplantation.

Consequently, potential recipients were “sequestered” on dialysis units.
It looked to me as if the patients whom we had set out to save fifteen years earlier had become pawns, dehumanized now by joining a captive population with limited options set by the entrenched bureaucracy. The supreme degradation for a patient must be to feel that the expression of a demand or a deviation from docile behavior can jeopardize his or her own case. This was not my imagination at work. The concept was confirmed in letters from or conversations with physicians or their assistants openly stating their proprietary relationships with their patients. They had forgotten that…patients belong to themselves—not to doctors….

A large cash flow can contribute to the fixation of therapeutic practices at an unsatisfactory level.. Because a major change requires inconvenient or expensive retraining, one refuge may be a blind adherence to, and even insistence upon, historically dangerous, morbid, and ineffective treatment practices. This is what happened in kidney transplantation.”  

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