How should society allocate organs?

The Roundtable convened to discuss the ethical issues of organ allocation as we approached the end of the semester. We began by comparing the UK and US systems for allocating scarce donated organs to patients. In the United Kingdom, patients are prioritized based on the number of "quality-adjusted life years" they would gain from a transplant, while the United States maintains a waitlist for organs, giving transplants to those who have been waiting longest. While the UK system seems to be designed to maximize utility, the US system seems to value the fairness gained in a "first come, first serve" system.

The question of whether the state can or should decided whose lives are more valuable was raised. While some discussants were uncomfortable with the idea of the state defining who deserves organs, others felt this was the best way to make sure highest value was placed on life. Still others were disturbed by the thought that some patients could be automatically handed a death sentence if they were too old or sick to receive an organ. The Roundtable considered various systems in which an element of chance gave hope to the majority of patients, while making it more likely that younger patients with a better chance of recovery would receive organs.

One particularly vivid metaphor used to represent organ waitlists was a group of shoppers checking out at a grocery store. If new shoppers keep arriving and butting in front of an individual, that just isn't fair; even if many shoppers can advance more quickly, those stuck in line have a right to a chance to get through by virtue of their waiting. People value fairness out of empathy for patients and their families. Furthermore, fairness upholds the rights of the individual at the cost of utilitarianism in order to make sure no one gets completely trampled.

Designing a system for allocating organs requires a holistic consideration of our values. The two opposing values that emerged in our discussion were life and fairness. Neither value can be set aside, so each needs to be weighed and addressed in the best possible way.

Other questions arose of whether some patients should be excluded from the waitlist system based on their past actions. The Roundtable seemed to agree that those who ruined their organs because of alcohol or drug abuse deserved transplants less than those who were "struck by lightning" and were not at fault for their illness. However, this decision was more out of concern that organs be well taken care of than out of retribution. Patients who can prove sobriety should be able to get new livers.

The real tragedy for those waiting for organs is that the longer they wait, the less likely they are to survive with their new organ. It is for this reason that most members seemed to agree that the best system would be a variant of the UK "life years" system, in which length of time on the waitlist could also be a factor. Organs should be used where they can be effective, but all people should have a fair chance at getting the transplant they need to live a healthy life.

Hopefully after this thought-provoking discussion, those of us who aren't organ donors will go sign up to become ones. Or maybe it’s time to plan a YSR kidney donation event...