Myth: Rationing of ESRD treatment is an unavoidable reality

  • Sidhartha Pani


Rationing means implicit or explicit denial of beneficial medical treatment as a result of insufficient resources to provide treatment to all. As a key example for nephrologists, a growing demand for solid organs suitable for transplantation, coupled with a static supply of organ donors, precipitated the current “demand crisis” with waits for a kidney exceeding five years in some communities. While it is only in the arena of transplantation that the United States medical community presently confronts a true rationing dilemma, the remainder of the world is forced to cope with insufficient funding for treatment of all potentially treatable ESRD patients by dialysis. The pragmatic reality is that fewer than one in five people living today would have any chance for ESRD therapy should their kidneys fail. It follows that a cohesive rationing policy should manage both the demand for ESRD therapy as well as the fair allocation of transplantable organs.


Organ Donor Fair Allocation Insufficient Resource Insufficient Funding Nation Practice 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Williams JI, Mahomed N, Chapeskie KK. Shorter waiting times for hip and knee replacement on the horizon. Hosp Q. 2000–2001;4:21.PubMedGoogle Scholar
  2. 2.
    Attaran A, Gillespie-White L. Do patents for antiretroviral drugs constrain access to AIDS treatment in Africa? JAMA. 2001;286:1886–1892.PubMedCrossRefGoogle Scholar
  3. 3.
    Steinberg EP, Gutierrez B, Momani A, Boscarino JA, Neuman P, Deverka P. Beyond survey data. A claims-based analysis of drug use and spending by the elderly. Health Aff (Millwood). 2000;19:198–211.CrossRefGoogle Scholar


  1. 4.
    Cohen LM, McCue JD, Germain M, Kjellstrand CM. Dialysis discontinuation. A ‘good’ death? Arch Intern Med. 1995;155(l):42–47.PubMedCrossRefGoogle Scholar
  2. 5.
    Cohen LM, Germain MJ, Poppel DM, Woods AL, Pekow PS, Kjellstrand CM. Dying well after discontinuing the life-support treatment of dialysis. Arch Intern Med. 2000;160:2513–2518.PubMedCrossRefGoogle Scholar
  3. 6.
    Stanton J. The cost of living: kidney dialysis, rationing and health economics in Britain, 1965–1996. Soc Sci Med. 1999;49:1169–1182.PubMedCrossRefGoogle Scholar


  1. 7.
    Giachino G, Saltarelli M, Chiappero F, Pigone E, Gigliola G, Piccoli GB. Survival of patients starting dialysis at an advanced age in Piedmont. Minerva Urol Nefrol. 1999;51(2):67–70.PubMedGoogle Scholar
  2. 8.
    Chandna SM, Schulz J, Lawrence C, Greenwood RN, Farrington K. Is there a rationale for chronic dialysis? A hospital based cohort study of factors affecting survival and morbidity. Br Med J. 1999;318:217–223.CrossRefGoogle Scholar
  3. 9.
    Mckenzie JK, Moss AH, Feest TG, Stocking CB, Siegler M. Dialysis decision making in Canada, the United Kingdom, and the United States. Am J Kidney Dis. 1998;31:12–18.PubMedCrossRefGoogle Scholar


  1. 10.
    Glover JJ, Moss AH. Rationing dialysis in the United States: possible implications of capitated systems. Adv Renal Replacement Ther. 1998;5:341–349.Google Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Sidhartha Pani

There are no affiliations available

Personalised recommendations