Bioethics of Organ Transplantation
Authors: Caplan Art 
Published: April 2013

Abstract

As the ability to transplant organs and tissues has grown, the demand for these procedures has increased as well – to the point where it far exceeds the available supply. There are also financial obstacles to access to transplant waiting lists in USA and other nations. There are severe limits on the availability of transplant services in many underdeveloped nations. Transplant physicians are well aware of this gap in supply and demand. They cope with the shortage by denying access to transplant centres to candidates on the grounds that some potential recipients are too old or medically ‘unsuitable’. This ‘scientific’ judgement often is based upon psychosocial factors. There is an active blackmarket in organ transplants internationally since many nations have no effective cadaver procurement system and some transplant centres are willing to guarantee an organ for the right price to noncitizens who can pay. Ultimately solutions to shortage in organs will involve better artificial organs, genetically engineered organs, regenerative techniques involving stem cells or the use of organs from genetically modified animals.

Key Concepts:

Although the demand for organs now exceeds the supply in every nation, the size of waiting lists would quickly expand were there to suddenly be an equally large expansion in the number of organs available for transplantation. Many older patients are not considered eligible for transplants but would be if more organs were available.

The waiting lists for cadaver organs have grown so long that a quiet form of triage takes place every day based on age, citizenship, ability to pay, potential for compliance and criminal record.

The reasons why the policy of encouraged voluntarism has not produced as many organs and tissues for transplant as might be expected are many. Large numbers of people still do not carry a donor card or other written directive specifying the disposition of their bodies when they die. Rates of donation among the poor are low. Some fear they will not receive adequate treatment if they say they are potential donors.

Donation is closer to being an obligation than it is to an extraordinary act of extraorindary moral beneficence or courage.

Transplant tourism remains an ethical challenge. For example, travel to China by foreigners to secure organ transplants has grown over the past decade. ‘Transplant tourists’ are attracted by a competitive price and a guarantee of a transplant. With no cadaver organ procurement system in place, the only way to guarantee the transplant of a liver or heart during the short time a transplant tourist is in China is to find matches among those in prison and execute anyone who is a suitable match.

Some transplant programs say they exclude some categories of patients from transplants because they have a history of drug abuse, a criminal convinction or because they have a mental illness or disability thereby giving strong reason for doubt about overall equity in the allocation of scarce organs.

In deciding what is fair in rationing organs the goal is to save lives and to get the most years of life from each organ. If so, then giving organs to the sickest persons who need them or the oldest is not necessarily the best way to allocate these life‐saving resources.