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Koch's book examines the origins of scarcity of blood and graft organs. The main finding is that the problem has existed at least since a famous legal case of U.S. v. Holmes, 1842, which dealt wit the question of lifeboat ethics - "who should die so that others might survive?" Koch looks at the lifeboat ethics' modern application to the distribution of transplantable organs. Using mapping software, the author reveals that "the scarcity of organs is exacerbated, where not created, by racial and regional inequalities inherent in the American health care and transplant system."