The British Transplantation Society has recently held its 6th annual congress. Their call for the setting up of a living donor transplant register of people who volunteer to give a kidney, a lung or part of their liver to strangers on the transplant waiting list, illustrates the topicality of this fascinating book on the ethical issues surrounding organ transplantation. Each year some 25,000 Americans receive organ transplants and another 5,000 die while waiting for them (the figures for Britain are about one tenth of these).

The author, Ronald Munson, received his PhD from Columbia University and held a Postdoctoral Fellowship in Biology at Harvard before becoming Professor of Philosophy of Science and Medicine at the University of Missouri-St Louis. He has also written a textbook on medical ethics and three novels.

The book is written from an American perspective and is directed at the general reader as much as ethicists, lawyers and the medical profession. Although jargon is avoided, enough technical information is provided to define the issues clearly.A series of dramatic case studies are described in a rather journalistic style. Most are based on fact with other characters and circumstances woven into the account to form a composite picture. These cases develop an emotional background to the very well argued analysis of the relevant ethical questions they raise. The author sets up a concluding viewpoint on each of the issues, giving his own opinion of the way forward. While his conclusions are generally sound, the case he puts forward for the sale of organs by live donors, albeit under strictly controlled conditions, does leave one somewhat uneasy. The difficulties that face the uninsured poor in America tend to colour his viewpoint here and demonstrates, graphically, the value we should place on our own National Health Service with all its faults. The concluding chapters on Xenotransplantation and Stem-Cell Engineering look to the future and anticipate the ethical problems we will face as progress is achieved in these fields.

The book is well written, carefully and accurately researched and not a little harrowing at times. There are few of us who would not be clearer thinkers in this difficult area for having read it.