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Risks, Paternalism, and the Gift of Life

Arthur L. Caplan, PhD; Mark Siegler, MD
Arch Intern Med. 1985;145(7):1188-1190. doi:10.1001/archinte.1985.00360070058008.
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As of Dec 31, 1983, there were 71,982 patients with renal failure on some form of hemodialysis or peritoneal dialysis in the United States. The Medicare program spent over $1.7 billion to reimburse the costs of their care. The total societal bill for these treatments was actually higher than the $1.7 billion figure since this amount does not include the costs of dialyzing patients in Veterans Administration hospitals.

During the same calendar year, 6,112 kidney transplants were performed. Approximately one third of these were obtained from living-related donors; the remaining two thirds came from cadaver sources. The average cost of transplant surgery was $35,000 in the first year and between $5,000 and $10,000 in the years postsurgery.

Increasing the number of kidney transplants would be of benefit both to patients with end-stage renal disease, whose quality of life would be improved, and to society, by reducing the financial burden dialysis


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