Chronic renal failure treated by dialysis and renal transplantation.

DR. MARSHALL: I must emphasize at the beginning that we shall not be talking about the management of acute renal failure, but rather of chronic and established failure. We are going to discuss extraordinary means of treatment as opposed to ordinary means. Ordinary means for life are things that a person is morally obligated to accept. These include the usual items, such as water, food, general care, and the available treatments of established benefit. On the other hand, one may accept extraordinary means, but one is not morally obligated to do so. Extraordinary means are not necessarily bad-indeed, some are quite good. How would progress ever be made if extraordinary means could never be used? WNe are now going to talk about renal homotransplantation, even mention autotransplantation; and we are going to talk about chronic dialysis, or the repeated use of the artificial kidney. These are certainly extraordinary means. Many interesting considerations come to mind. One could speculate upon the question of the supply and the demand. I don't know whether you ever thought about it, but if 50 per cent of the renal homotransplants would function sufficiently to maintain an individual in good condition for 3 to 5 years, would the populace accept this with delight? It now seems much better to transplant between persons who are related than between persons quite unrelated. This would dictate that if you have a large number of brothers and sisters, you'd be a sort of walking bank for them, not only for a kidney, but for a lung, a piece of liver, and probably a few other things. The risk of parenthood is already significant; but in the future, the more children you have, the