Rules for America's organ transplant centres are to be tightened after a series of scandals revealed embarrassing gaps in the national system. If the rules are strictly enforced -- and they have not been in the past -- 64 of about 500 transplant centres could close. Each of these has failed Medicare standards for volume, patient survival or organ survival.

The problem in the US is not a lack of transplant centres, but a lack of organs. A number of specialists strongly believe that there are too many substandard hospitals where too few operations were done to maintain their competence. A crusading Los Angeles Times has blown the whistle on bad programs in California. One, UCI Medical Center in Orange, had to close its liver transplant unit because it did not have a full-time transplant surgeon and people on its waiting list were dying. Kaiser Permanente closed its kidney transplant program in San Francisco because hundreds had been endangered by delays or by losing track of patients.