The technical challenge of performing organ transplants is nearly nonexistent, and great progress has been made in understanding and overcoming the barriers associated with the immune system. The questions are no longer, “Can we perform organ transplants?” and “Which ones?”. These questions have been replaced by a much more complex one, “Who should be offered the therapeutic option of transplant?”. This article explores the concept of limited access to a vital care option, organ transplantation. The two major factors that limit unrestricted access are the high cost of organ transplantation to the individual and society, and the limited supply of donor organs. These issues are discussed within the framework of, and how they affect, patient selection for transplantation.

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