In September 2001, the British medical journal Lancet published a retrospective report of nine British patients who received combined heart-lung-liver transplants between 1986 and 1999.1 In each of these cases, three vital organs went to a single recipient when they might otherwise have gone to as many as four. This kind of transplantation works against the received wisdom that transplantation works best when focused on a single vital system or at least no more than two. According to the study, four of the recipients lived no longer than four months after the transplant, three died after a period of years (2.5, 7.5, and 12), and two were still alive at the time of the report. The authors believe that different approaches could help control the infection that caused most of the sickness and death in the cases reviewed. Because five patients survived beyond the immediate posttransplant period for a time measurable in years, the authors recommend the procedure for patients of a certain kind, especially since it does not require new skills for experienced transplant teams. The procedure does require more organs, however, and not only for this reason raises many ethical questions that should be addressed before transplantation of this kind continues on any large scale. The report contains no information about how consent was obtained f om patients involved in this procedure. One hopes ha the informed consent procedure fully emphasized the risks of the intervention. Especially for these early attempts, on hopes that the experimental nature of the procedure was emphasized. Of course, in the United States, federal regulations do not require that physicians obtain prior review and approval for clinical innovations aimed at the care of a particular patient. This means that physicians in this kind of situation are under no obligation to submit their informed on ent process to the scrutiny of others. While the Belmont Report was not written for a British audience, its counsel is nonetheless wise about clinical innovat on. That 1976 report recommends that radical innovations should be made the object of formal investigation as soon as practical after first being tried. It seems to me that the time is more than ripe to treat multiple organ transplant as experim ntal in a formal sense and to subject it to scrutiny in regard to its procedures and informed consent process. I say this not to cast any aspersions on the practices of the physicians who were involved in the cases reported, about which no information is available. I say this because institutional review boards can, on balance, offer important assistance both