High cost dialysis and transplantation — dilemmas for nephrologists and nations

The linked successes of dialysis and transplantation pose dilemmas for nephrologists struggling to meet the clinical need and for health care planners wondering where to find the resources required. The low rate of acceptance of new patients in the UK compares unfavourably with the service given in other countries. Successful rationing is achieved by a sparse distribution of centres and of specialists and operates through a low rate of referral of patients to nephrologists. Political initiative is beginning to emerge to redress the underprovision of facilities by setting realistic targets before regional health authorities.