The extremely limited number of human organs available to those waiting on transplant lists required doctors to develop a system to determine who gets on the list and in what priority. Before 2002, placement in the intensive care unit bumped a patient up on the waiting list for livers. But after the rule changed in 2002, the number of liver patients in the ICU plummeted. Lung doctors adopted a system based on objective medical data. “There’s really no way for me to manipulate that score to put that patient higher on the list,” said Marie Budev. “There’s really no way to game the system.” If not for regular audits that serve as an extra check on the system, Budev said she might be more tempted to bend the rules. “That patient is everything,” Budev said. “And that’s why I think we can’t be trusted.”

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