The University of Pittsburgh Medical Center once dominated the lucrative business of liver transplants, but as the procedure grew more common competition from other hospitals eroded its monopoly. Earlier this decade, UPMC made an aggressive bid to reclaim its leadership by hiring an innovative surgeon named Amadeo Marcos. Marcos delivered on his pledge to double the number of liver transplants the hospital did. In doing so, however, he resorted to practices that some colleagues found questionable. UPMC's quest to ramp up its transplant business shows how a drive for higher revenue, now common at nonprofit hospitals, could risk compromising patient care.