Ethical Aspects of Organ Allocation in Transplantation

Abstract

Of the two major ethical issues surrounding organ allocation—determining criteria for expanding the size of the organ pool and determining criteria for allocation itself—I focus on the issue of allocation, and begin by assuming that there are five main criteria for use in deciding who gets a donor organ: age, medical benefit, merit, ability to pay, and geographical residence. I discuss each of these in turn, eliminating age because it fails to indicate the overall status of a patient's health; eliminating merit because physicians have neither the time nor the ability to act as judges; choosing medical benefit as the best criterion because it is fairest and does not call for such judgements; and leaving open considerations of ability to pay and geographical residence, for application in the event the issue cannot be decided on the ground of medical benefit alone. These criteria, I conclude, are best treated as guidelines, and not as rules. (Texas Heart Institute Journal 1987; 14:284-288)

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