It has been said that, “. . . it takes years to build up trust, and it only takes suspicion, not proof, to destroy it.”[1] The words themselves tell us something about human nature, and unfortunately, are prescient in the context of organ transplants. At a time when a severe shortfall in donation has become emotionally palpable—approximately 18 people die every day while waiting—transplantation survives, imbedded within a fabric of trust. Those who donate their or their loved one’s organs expect that certain precepts will be honored. For example, there is the dead donor rule. If someone has agreed to donate organs after they die, either by whole brain or heart criteria, they must be dead and not merely dying when organs are retrieved. As a result, fiction like Robin Cook’s Comacan send a shudder throughout the transplant community. Similarly, in the mid 1990s, when newspapers intimated that cardiac criteria for death may have led to premature organ retrieval, concern was immediate and intense. Americans also respect a “level playing field.” Remember the public outcry surrounding Mickey Mantle’s liver transplant? Allowing the famous or rich to jump ahead of the vulnerable is not the American way. Finally, in an era of quality and safety concerns, the lifesaving process of transplantation should be transparent, compassionate, just, and as safe and quality laden as possible. There are diverse “patients” involved: donors, recipients, and both families. The public should continue to be very sensitive to potential abuses. This necessary vigilance represents transplantation’s critical check and balance.

What is good medicine? Who counts as a good doctor? These are very large questions that cannot be fully addressed here. I want to focus on a basic aspect of these two questions and on the ethical idea of "the good." The term "good medicine," as I have just used it, is not intended to be contrasted with "bad medicine." Rather it is meant to bring to the fore that medicine is something good in itself, a worthwhile and honorable human activity, a "profession" with a specific object of activity, a human good, to which so many men and women devote their lives; an endeavor full of value and capable of fulfilling a person's life with interest, effort and achievement.

Tirhas Habtegiris was dying of cancer. The 27 year-old legal immigrant was being kept alive on a ventilator at the Baylor Regional Medical Center in Plano, TX. Tirhas was desperately hoping to hang on until her mother could arrive from East Africa, but a joyful reunion and sad goodbye never took place.