ABOUT a year ago, on July 1, 1973, the federal government activated a new law under which it assumed fiscal responsibility for the treatment of end-stage kidney disease in all patients covered by Social Security. This marks the culmination of a decade and a half during which two dramatic therapies for irreversible kidney failure have come to maturity: hemodialysis with artificial kidneys, and renal transplantation. Even though both cannot yet be regarded as optimal treatment modalities, they are probably here to stay as long as the nation is confronted with an annual toll of 60,000 uremic deaths. According to the National Dialysis Registry of the National Institutes of Health (NIH), the number of patients who are currently being maintained with the aid of chronic dialysis approaches 14,000. According to the American College of Surgeons/NIH Organ Transplant Registry, more than 8,000 renal transplants have been performed thus far in the United