The specifics of any given medical ethical dilemma are often influenced by much larger forces. For example, the doctor-patient relationship has become a commercial transaction because of growing privatisation. Medical costs can be determined by how much a person or institution 'needs' to recover expenses, or make a good living -- as well as the patient's need for treatment and the other available options. The kidney transplant racket could not have happened without the availability of advanced medical technology -- and a desperately poor population waiting to be exploited.