CHEYENNE -- You don't hear much talk any more about death panels in connection with national health care reform.

It was a big deal last summer, however, as opponents tried to demonize the proposal by suggesting it would lead to committees deciding who lives and who dies.

That would be the ultimate in health care rationing.

The proposal wasn't nearly that drastic. And health care rationing isn't a new idea.

About 50 years ago some communities decided who would get kidney dialysis.

Before the invention of the blood filtering machine, there was no cure for chronic kidney failure. Patients with failing kidneys got worse and died.

Then, in the early 1940s a Dutch physician, Willem Kolff, invented a primitive machine to cleanse the blood of people with end-stage kidney disease. It consisted of 50 feet of sausage tubing wrapped around a rotating wooden drum set in a special solution, according to an article in

"Governing" Magazine.

The first 15 people who tried it died.

But by 1945, Kolff got his "artificial kidney" to work. He moved to the United States and with other scientists, improved on the invention.

The magazine story features a photo of an early kidney dialysis machine from about 1947. It shows a big, unwieldy looking cylinder with a line attached to the arm and the vein of a bedfast kidney patient.

By 1961, scientists in Seattle developed a Teflon shunt that allowed patients to receive dialysis indefinitely.

The catch was the cost -- $10,000 per year.

When physicians at the University of Washington hospital wanted to expand the program, the administrators and the state fretted it would get stuck with the cost.

So a foundation invested enough money for three dialysis beds.

The next step was to decide who got the beds.

Two committees were established.The first included kidney specialists who examined the patients to see if they were suitable candidates for dialysis.

A second committee made the final decision on who got the life-saving treatment.

It included a union leader, a lawyer, a doctor, a businessman and a pastor.

They based their choices on the patient's "social worth."

The second committee chose 10 out of the first batch of 17 patients for dialysis. The other seven died.

Similar panels were set up in other communities across the country.

In general, however, people who could afford to pay for the treatment themselves lived. Those who couldn't died.

In 1972, the new Medicare health insurance program stepped in and paid for dialysis. This ended the agonizing life-or-death decisions.

Today, the article said, dialysis saves more than 300,000 lives per year.

Today, Wyoming has nine dialysis treatment centers.

In 1971 the Legislature created the Wyoming End Stage Renal Disease Program.It helps low income people with treatment of their chronic kidney disease after Medicare or Medicaid have made payments.

With kidney transplants, the program covers only the cost of immunosuppressant drugs.

"We're the provider of last resort," said Jim Wolf, manager of community services for the Wyoming Department of Health.

If the patient meets income guidelines -- 185 percent of the federal poverty level -- and has exhausted other resources, the program will pay for treatment, transportation, medications and even insurance premiums.

Although the best treatment is a successful kidney transplant, there is more demand than a supply of organs available.

The program helped 168 people in the last fiscal year, including 137 with dialysis and 31 with transplants.

So far this year the total is 145 patients, including 114 on dialysis and 31 transplant cases, said Cherame Serrano, benefit specialist with the program.

And there's no committee to decide which patients have enough "social worth" to merit the treatment.

Contact Joan Barron by e-mail at joan.barron@trib.com or by phone at (307) 632-1244.