Choosing Dialysis Patients

It is a generic, common hypothetical ethics question. You and four others are stranded on a desert island, in charge of rationing out the food. There is only enough food for four people. One of you, therefore, is destined to die. And you have to make the call.

Thankfully, this is a hypothetical… usually. Rarely, if ever, do decisions like that need to be made in such an explicit way. But in 1962, a Seattle hospital had to do just that.

The technology behind one of the more common forms of kidney failure treatment, hemodialysis, is relatively new. In 1960, Dr. Belding H. Scribner developed a shunt, now called the Scribner shunt, which allows for outpatient dialysis — a treatment which, according to the National Institutes of Health, over 300,000 Americans (as of 2007) required. And in 1962, the hospital he worked at created the Seattle Artificial Kidney Center, with six dialysis machines running. The immediate problem: there were many more patients the machines could possibly treat.

And without receiving treatment, a person in kidney failure will die.

Met with this problem, the Center set up a committee which, in effect, looked at the resumes of the potential patients and decided, quite literally, who would live and who would die. The committee was comprised of various community members — clergy, lawyers, housewives, government officials, and yes, a doctor or two. Their identities were otherwise kept anonymous, most likely for their own protection. As Futility Closet reports, “The preferred candidate was a person who had demonstrated achievement through hard work and success at his job, who went to church, joined groups, and was actively involved in community affairs.”

By the early 1970s, the committee was no longer needed, as the federal government prioritized bringing dialysis nationwide.

Bonus fact: Seattle has a reputation for being the wettest city in the United States — it always seems to be raining, or so the tale goes. The truth? It receives about 37 inches of rainfall annually, which is nowhere near enough to crack the top 10.

From the Archives: The Toxic Lady: A patient who probably would have failed to get dialysis under the Seattle system.

Related: You can’t buy a kidney on Amazon (obviously?), but you can buy a “4D Human Kidney & Renal Corpuscle Anatomy Kit” for $15 and change.

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