Book Review Ethical Problems in Dialysis and Transplantation (Developments in Nephrology. Vol. 33.) Edited by Carl M. Kjellstrand and John B. Dossetor. 235 pp., illustrated. Boston, Kluwer Academic, 1992. $108.50. 0-7923-1625-8
In 1960, kidney doctors lost their innocence. Prioritizing, rationing, and exclusion, before 1960, were words alien to the lexicon of renal medicine. Before that year, except for patients treated by Alwall in Lund, Sweden, and Merrill in Boston, who applied hemodialysis to acute renal failure, the diagnosis of uremia meant death in days or weeks. Proposals for repetitive hemodialysis in patients with uremia were termed “unethical” and “cruel” and were considered needlessly stressful for patient and family in protracting the inevitable. I recall being taught the use of magnesium sulfate and chloral hydrate injections to mute agonal uremic seizures. Physicians committed to the study of the kidney conducted repetitive, unproductive explorations of sodium, potassium, and chloride transport in the rat nephron. Awards from the National Institutes of Health mainly supported exploration of where and how the rodent nephron secreted uric acid, how diuretics blocked canine sodium reabsorption, and ion transport in the toad bladder. Dominant renal physicians evinced minimal interest in two-legged subjects with failing kidneys. Physiologists owned the kidney and its diseases.