Patient selection committees: should they be reinstituted?

Chronic renal failure is no longer synonymous with death. Federal and state government funding for end stage renal disease (ESRD) services and advances in modern technology now make the prolongation of life possible for almost any individual with renal failure. However, the same medical devices and sources of funding that support renal replacement therapies have also contributed to the moral and ethical debates that surround these treatments. Discussions regarding quality of life, rehabilitation statistics, functional status data, prognosis, decision making protocol, and selection criteria provoke much controversy in the nephrology community and remind us of the "Death or God Committees" utilized in the pre-Medicare days to make decisions regarding access to dialysis treatments. In this issue of ANNA Journal, Marguerite Hartigan and Christy Price revisit the issue of selection criteria and explore the advantages and disadvantages of using established protocol to access the services of the ESRD Program and nephrology community.