Which patient to operate? The ethics of providing heart surgery in developing countries

Background Approximately 90 percent of the world’s population lives in countries with little or no access to cardiac surgery. Initiation of a surgical program results in a large influx of patients, of whom only a small proportion can be selected for surgical intervention. In addition, at times program development goals may conflict with patient care goals. When surgery cannot be provided to all the patients who need it, it is worthwhile to examine the ethics of patient selection.