Should transplantation be a part of a health care system?

The inclusion of organ transplantation in our health care system raises several questions about the basis for the decision and the process by which it was approved. To function, our health care system requires not only an adequate method for technical evaluation, but also a means for ensuring informed public support for the policies that determine what services are available. In the future, this approval process could lead to the exclusion of a treatment because the system as a whole would not be able to afford its cost. This exclusion could have important implications for the philosophy of medicine and the work of the clinical investigator.