The politics of grafting cadaver kidneys.

waste of a kidney, and in money itself. Renal transplantation is cheaper only if the patient and graft survive more than 18 months. If a patient dies within that period, long-term costs would be saved and renal transplantation would have been a very expensive form of euthanasia. Diabetic patients and patients with cardiovascular co-morbidities should be strictly screened. This proposal is easy to monitor. The end-points are clear-failed kidney and patient's death. Units retain their clinical freedom but will have to live with the consequences of their judgment and decisions. Mandatory audit and publication of efficiency measures, such as the ratio of kidneys per working transplant and waiting times, provides further incentives to strive for excellence. This new approach would reduce the present paternalism, and patients, their family doctors, and purchasers can make an informed choice. Most imponantly, patients will benefit from the improved clinical efficacy and efficiency.