The ethics of need-based and merit-based organ giving

Already under the status quo doctors carry out an analysis before they make a decision whether to try an operation or not. There are cases when patients are hopeless and an operation won’t help them anyway. By denying them doctors save valuable transplants for other patients that are more likely to succeed with their operation. The opposition today is stating that the need-based criteria is the only one in deciding who to give a transplant. Well, no. There are other factors included in the process of evaluation. Let’s take a look at the system implemented in California to which the opposition has referred in their counter-model and see what are these criteria. First it states that liver transplants are given to those patients that obtain maximum benefit from the procedure. Thus, it already implies the utilitarian approach. Then there is a list of diseases that qualify for having a transplant. There is also a part called “Contradictions to Transplant” where it is written in which cases doctors absolutely deny patients in having a transplant. This includes usually diseases or processes that significantly decrease the chances of a successful operation. And, among others, it includes “Active alcohol or substance abuse”. There are also “Factors that increase the risk of liver transplantation”, and these include “Advanced age”, “Chronic hepatitis B”, “Severe malnutrition” etc. It is not necessary that an operation will definitely be unsuccessful if a patient qualifies in one of these groups, but these factors decrease the chances of success and increase the costs of the operation. Doctors have a right to deny referring to these criteria to save valuable transplants for other patients and to save money, because operations to other patients will be cheaper. Thus, it implies the utilitarian approach. There is a set of criteria used specifically to evaluate alcoholics. A patient with alcoholic cirrhosis will undergo a special scrutiny. The idea is to search for indicators for continued sobriety following the operation. And the criteria used are previous social stability, employment record and psychiatric status. This is a case of direct evaluation of patients in the counter-model our opposition has brought up. [[http://www.cpmc.org/advanced/liver/patients/topics/transplant.html]] We see that this model allows direct discrimination based on social status and employment, and this proves that necessity is not the only criteria used. In fact, such questions as “What’s the point of giving this man a new liver when he’s an alcohol addict who will probably relapse?” are already asked. And they are asked by the group of doctors including surgeons, psychiatrists, social workers, dietitians. Referring to the Hippocratic Oath and other ethical guidelines we see that our plan simplifies lives of doctors, and takes away the burden of deciding and guilt of denying from them. Doctors evaluate patients even now, and the doctor facing a case of alcoholic cirrhosis should make a difficult ethical decision. On the one hand he has to help as many people as he could, but on the other if he helps this alcoholic, who is guilty in his disease himself, he is taking away chances of helping others. Other patients will have to wait for a new transplant, and there is a possibility that they die before they get a new organ. In the United Kingdom the burden of the decision whether to give a patient a liver is also lying on doctors. They have some guidelines and they are much wider than to give an organ to patient who needs it the most. [[http://www.uktransplant.org.uk/ukt/about_transplants/organ_allocation/liver/national_protocols_and_guidelines/protocols_and_guidelines/adults.jsp]] We see it only as a benefit of our model if we take away the burden and the guilt of denying from doctors and pass it in the form of legislation. To sum up, we see that under the status quo doctors use several criteria in deciding who to give a new organ, not only the necessity. If it is allowed to use socio-economic status in this process, we see nothing bad in using the past behavior as a criteria. Our plan doesn’t contradict the general ethic guidelines used by doctors, but it takes away the burden of difficult decision making process from them and passes it on the legislation in the case of alcoholics. And the state has such a right, since organ transplants are treated as a national resource in most of the states. [[http://www.uktransplant.org.uk/ukt/about_transplants/organ_allocation/liver/national_protocols_and_guidelines/protocols_and_guidelines/adults.jsp]]