Priority Systems in the Allocation of Organs for Transplant: Should We Reward Those Who Have Previously Agreed to Donate?
Health Law Journal, Vol. 13, 2005
38 Pages Posted: 18 Nov 2005
The shortage of organs available for transplantation is a source of much avoidable suffering, loss of life and expense. This shortage has led to many proposals to encourage higher donation rates. Among these proposals is the suggestion that those who register as donors should receive some degree of preference in the allocation of organs should the registrants themselves turn out to need an organ later on. This "priority system" is a form of incentive system that may raise ethical concerns with respect to both the donation side of organ transplantation as well as the allocation side. From the perspective of donors, some suggest that the system is coercive and erodes altruism. With respect to allocation, the system would prefer some potential recipients over others. While this is necessary in any non-random system of rationing scarce resources, critics suggest that the criterion of previously-expressed willingness to donate would operate unfairly and also reflects an impermissible method of allocation according to adjudged social worth. Other concerns exist regarding deviation from allocation according to need or medical utility, as well as with respect to the commodification of body parts. This article considers the critiques of priority systems, discusses the advantages and disadvantages of using a priority system, and offers suggestions about how an ethically acceptable priority system might be designed.
Keywords: organ transplantation, organ donation, health law, health policy, medical ethics, biomedical ethics, discrimination
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