Organ transplants are scarce, so they should be allocated, and decisions should be made about who will receive the transplant. Those are hard decisions, as people’s lives usually depend on them: if one will not obtain the transplant, they will die, or their lives will be miserable. However, for now, there are no other choices, which means that ethical systems should be used to decide on allocation to maximize the cumulative benefit and minimize possible problems.
Transplantation is an efficient way to cure patients with severe health problems connected to solid organ malfunction. However, only a fraction of patients may be cured due to the transplant scarcity, conflicts of interest, and expense of the procedure (Machado, 2019, ch. 10). Decisions about who deserves to live and who is not are hard and prone to cause conflicts. They can be made unfairly, for example, based on the sum of money that one can offer for their treatment.
To cope with those issues, several ethical systems help to decide who should obtain organs first, and medical stakeholders use them actively. Specifically, there are egalitarian, utilitarian, value for society, worst-off, and own-fault approaches, as well as their various combinations (Oedingen et al., 2019, p. 476). The egalitarian approach offers everyone an equal chance to obtain an organ, which means no preferences. However, due to the scarcity of organs, it will not help everyone to be cured and may cause conflicts.
The utilitarian approach prefers those with the best chances of survival and quality of life after the transplantation. Similar to it is value-based, which proposes placing on the top of the allocation queue those who are valuable for society, for example, doctors or various prominent people. Own-fault means that those with health problems due to their self-destructive lifestyle and bad habits should be at the end of the allocation queue. Lastly, the worst-off approach prefers allocation to people with the worst conditions and will probably die without transplantation.
Understanding social preferences are essential in making those decisions to ensure the fairest and most egalitarian allocation. Social responsibility is critical there, as ill people usually cannot help themselves and should rely on doctors and the community’s help (Oedingen et al., 2019, p. 487). Medical facilities should be organized to avoid dissonances, such as conflicts between the personnel and patients, which will allow them to treat people more efficiently (Machado, 2019, ch. 8).
For that, clear criteria should be presented from the very beginning, to avoid false hopes for those who will probably not be able to obtain an organ. However, the mentioned ethical systems sometimes contradict each other: for example, the worst-off approach prefers people with the hardest conditions and high emergencies. Those people usually have fewer chances of survival and, thus, are not selected by the utilitarian approach (Oedingen et al., 2019, p. 486). It means that ethical systems are better to be used combined, and each decision should be made individually, based on all facts and prerequisites of the situation.
Therefore, medical facilities use various ethical systems to make the hard decision about transplantation priority. The egalitarian approach tends to grant everyone an equal chance to obtain a transplant, while a utilitarian prefers those who are valuable to society and will have the best life quality after the transplantation. Other systems are worst-off, preferring helping patients with the worst conditions; value-based, favoring those who are valuable to society; and own-fault, limiting help to those who caused their health problems by bad habits. Those systems help to make better decisions when used together, for each case individually. Organ transplantation facilities should be well-organized to prevent possible conflicts of interest and the spread of false hopes.
References
Machado, N. (2019). Using the bodies of the dead. Routledge.
Oedingen, C., Bartling, T., Mühlbacher, A. C., Schrem, H., & Krauth, C. (2019). Systematic review of public preferences for the allocation of donor organs for transplantation: Principles of distributive justice. The Patient – Patient-Centered Outcomes Research, 12(5), 475–489. Web.