What regulation shall we have for the operation? Shall a man transfuse he knows not what. to correct he knows not what. God knows how (l)? Dr. Henry Stubbs Royal College of Physicians circa 1670 If dialysis therapy were a new phannaceutical product being evaluated by the FDA now, it might not be approved for marketing. The recommended dose, its potential toxicity, the side effects of under-or over-dialysis as well as its efficacy have been the subject of very few studies. The high mortality rate associated with the treatment may raise a few eyebrows. That it is a life-saving modality of treatment is undoubtedly true for more than 100,000 patients in the United States and for more than a million patients world wide. Because dialysis has extended the lives of many people by a variable period of time, most nephrologists have "rested on their laurels" and did not vigorously pursue studies to optimize these treatments. But facts have a way of intruding in all our lives and the facts are that the overall mortality rate of dialysis patients in the United States is rising and stands close to 25% per year and is closer to 33% per year for patients between the ages of 65 and 74 (2). These mortality figures are considerably higher for age-adjusted dialysis populations in Europe and particu larly in Japan, and certainly for the age-adjusted nonnal population."

What regulation shall we have for the operation? Shall a man transfuse he knows not what. to correct he knows not what. God knows how (l)? Dr. Henry Stubbs Royal College of Physicians circa 1670 If dialysis therapy were a new phannaceutical product being evaluated by the FDA now, it might not be approved for marketing. The recommended dose, its potential toxicity, the side effects of under-or over-dialysis as well as its efficacy have been the subject of very few studies. The high mortality rate associated with the treatment may raise a few eyebrows. That it is a life-saving modality of treatment is undoubtedly true for more than 100,000 patients in the United States and for more than a million patients world wide. Because dialysis has extended the lives of many people by a variable period of time, most nephrologists have "rested on their laurels" and did not vigorously pursue studies to optimize these treatments. But facts have a way of intruding in all our lives and the facts are that the overall mortality rate of dialysis patients in the United States is rising and stands close to 25% per year and is closer to 33% per year for patients between the ages of 65 and 74 (2). These mortality figures are considerably higher for age-adjusted dialysis populations in Europe and particu larly in Japan, and certainly for the age-adjusted nonnal population."

As any new field in medicine develops, an the history of transplantation and the current accompanying documentation occurs in a rea status of hemodialysis as it relates to trans sonable and logical sequence. Early in the de plantation. In addition, the areas of tissue his to velopmental life of clinical transplantation, compatability typing, patient evaluation, the many research articles and case reports were transplant operation, immunosuppressive drugs, presented in the literature, and shortly there and follow-up investigations are well and clearly after, a series of textbooks were published. documented, as are the medical complications These textbooks dealt primarily with the per and the psychiatric and social problems en sonal experiences of clinicians working in the countered in kidney transplantation. major centers, who were embarking in the new Although Dr. Chatterjee draws primarily on field, as were Dr. Starzl, Dr. CaIne, Dr. Sim his own experiences, he fairly presents all the mons, and myself. This field of investigation has issues in areas in which there is controversy or now become an accepted clinical discipline, and differences of opinion. Most major university thus it is highly desirable that a manual should medical centers now have a clinical renal trans be available for the residents and house staff plantation service, and I feel that this manual who will receive training in this important area. will be an invaluable tool for their house staff In this manual, Dr. Satya N. Chatterjee pre and students alike."