Limiting Access and Patient Selection in Liver Transplantation

To the Editor: Under new Health Care Financing Administration rules, liver-transplantation programs must show a 77 percent rate of survival at one year among their patients to be accredited to receive Medicare funds. We believe this may place physicians in the ethically compromising position of having to choose between program accreditation and patient treatment. This leads us to three observations. First, the social contract of American medicine presupposes that the doctor is the patient's advocate, not an advocate for society against patients whose care is costly or patients whose condition is such that the doctor cannot be sure that procedures . . .