Cost-Benefit Analysis and Heart Transplantation

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Abstract
Amid a flurry of controversy, the trustees of the Massachusetts General Hospital have disallowed heart transplantation by the cardiac surgical service.1 Meanwhile, the Mayo Clinic is establishing a new heart-transplantation program.2 Moribund in the 1970s, the procedure is reviving as a potentially viable clinical option, now that five-year survival rates are exceeding 50 per cent.2 The question, "Can it be done?" has changed to "Should it be done?" with major medical institutions splitting both ways.Cash is the bottom line. In 1972, when Medicare coverage was extended to patients with renal failure, it was "only a question of money." 3 Since . . .

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