Rep. Shelley Berkley, (D-Nev.), and her successful campaign to save Nevada's only transplant center has drawn a lot of controversy because of her close ties to the renal industry. Her husband, nephrologist Larry Lehrner, MD, directs medical services at the hospital. 

When the Centers for Medicare & Medicaid Services moved to cut funding to Nevada's only transplant center because of its unusually poor outcomes, Berkley helped the hospital broker a deal. The hospital agreed to a plan to improve transplant outcomes and CMS made the unprecedented decision to reverse its move to cut funding. This is where the deal gets murky. The hospital hired Lehrner's practice to recruit new transplant surgeons and expanded its contract with the practice to a total worth of $738,000 a year, The New York Times reported.

This might immediately seem shady, that Berkley was essentially brokering a deal for her husband, not the transplant patients who also happened to benefit. But it is important to keep in mind that Lehrner's practice was the only one that bid for the contract, The Times reported, and Nevada has a shortage of qualified nephrologists. The hospital has also greatly improved its transplant outcomes.

Did Berkley have her husband's interests at heart (and by proxy her own financial interests)? Or was she worried about how shutting down the state's only transplant center might affect kidney patients? We will probably never know the answer to these questions. But if you are a transplant patient who has benefited from the newly organized center, you probably do not care. The important factor here is the patients. And that essentially sums up much of this country's health care system; it is all means to an end. And for kidney patients in Nevada, this may have been a pretty good end.

But this is not the only time Berkley has pushed her husband's agenda. According to The Times, Lehrner helped build the Renal Physicians Association political action committee, which has often used Berkley to champion its causes. Lehrner is joint owner of several DaVita dialysis clinics, and DaVita has contributed to Berkley's campaign.

Berkley's ties to the industry are not illegal. But my fear is that these kinds of cozy relationships between lawmakers, doctors and dialysis clinics push these health care issues even further away from the patients, who should be at the center of such issues. As a society I think we like to hope that doctors always have patients' best interests in mind. But I don't think that policies that benefit doctors, or dialysis providers, always benefit patients. Kidney care is big business in this country and businesses worry about the bottom line. The hope is that the bottom line is always in line with the patients' best interests.