In the last decade, the debate over the ethics of organ and transplant allocation has intensified and the attention sensationalized in the media. At the core of this issue, critical questions remain. They include but are not limited to those regarding economics, race, and geographic inequity and about the moral relevance and weight of geography, economics, and other disparities and inequities in transplant allocation (Stanford University, 2012). Transplant allocation raises questions regarding the four of the basic major ethical principles of medical ethics: autonomy, beneficence, justice and non-maleficence. As such, bioethicists typically refer to the four principles of health care ethics in their evaluation of the merits and difficulties of medical procedures such as transplants. With regards to issue of transplant allocation, the four ethical principles can be applied to the issue in the following ways:
The principle of autonomy involves the patient having ‘a voice,’ ownership, autonomy of thought, action, intention and level of advocacy when making decisions regarding their health care procedures. As such, and as it relates to transplant allocation, the decision-making process should and must be free of coercion or coaxing of all involved and even the families of deceased individuals (Robertson, 2005; SU, 2012). In order for a patient and for families to make educated and fully informed decision, they must understand all risks and benefits of the allocation and the actual transplant procedure as well as the likelihood for success, especially since the process can illicit intense emotions, financial and physical set-backs(SU, 2012).
This principle stipulates that the transplant allocation and procedure be solely conducted with only the best intent of doing well for the patient(s) involved. As such, the principle then also requires that health care providers develop and maintain the needed skills and knowledge, that they continuously update training and educational courses, consider individual circumstances of each and every patient, and strive to maximize the benefits as healthy and positive as possible (SU, 2012).
The principle of justice is grounded in the idea that the burdens and benefits of new or experimental treatments must be distributed equally among all groups in society. Therefore, as it relates to transplant allocation, the allocation or access to organs should be a fair process and not one in which ‘the highest and wealthiest bidder gets the organ transplant or the mere fact of only the rich have access to health insurance. That is not justice fair or equitable distribution of healthcare and in this case transplant allocation (Childress, 2001). The principle requires that transplant allocation and procedures uphold the spirit of existing laws and are fair to all players involved. As such, the health care provider must consider the four main areas when evaluating justice: fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation (SU, 2012).
This principle requires that a transplant procedure does not intentionally or maliciously bring unanticipated harm to the patient, donor or others involved in the process. Surgeons operate under the assumption that they are doing little to no harm by pursuing the greater good. However, overall desired outcomes must be facilitated through the careful monitoring especially since transplant allocation can be inequitable, unfair and even the procedures do fail and can affect the emotional state of the patient. In some extreme cases, sometimes it is difficult for doctors successfully to do no harm principle (SU.2012).
Transplant allocation often has a ripple effect as Burdick(2005) asserts: “Because there are not enough donated organs, all patients and practitioners are bound together by a community of medicine principle: whenever a patient receives a transplant, it diminishes the chance that other potential recipients will be able to receive this gift of life in time to save them.”(275). Other very sad and disturbing well-known facts include but are not limited to: although through organ transplants many people have been helped and given a new ‘lease on life,’ a growing number of transplant candidates suffer and die waiting for life-enhancing or life-saving organs that just never materialize (SU, 2012).
In conclusion, it is imperative that we stop, think and ask: How are organs for transplant allocated? How should they be allocated? In accordance with which ethical principle, theory, or precept? Should this scarce, expensive, life-saving therapy be only available to those who can ‘afford’ it and should it be distributed among the growing numbers of those who need it? (SU, 2012). According to Childress (2001), “the success of policies of organ procurement may reduce scarcity and hence obviate some of the difficulties of organ allocation. However, distrust is a major reason for the public’s reluctance to donate organs, and policies of organ procurement may be ineffective if the public perceives the policies of organ allocation as unfair and thus untrustworthy.” (p. 366). Transplant allocation creates ethical dilemmas because like general health care and health insurance, access and treatment are not equally available to everyone.
Subsequently, in order for a medical practice to be considered “ethical”; it must respect all of the four ethical principles. Furthermore, it is critical that medical professionals, bioethicists, patients, and health insurers be cognizant of potential conflicts of interest when formulating and evaluating policies regarding transplant allocation (Burdick, 2000; SU, 2012). Many ethical and moral questions remaining include but are not limited to: racial and ethnic inequity, the moral relevance and weight of waiting time, the ethics of directed donation to individuals and groups, as well as those regarding the overarching ethical framework in which organs for transplant should be allocated. With such compelling questions and related aspects considered, it is mandatory, critical, inevitable and beneficial for all involved that the Council on Bioethics pays very close attention to the ethics of organ allocation.
Burdick, J. (2000). Responses to a critique of UNOS liver allocation policy by Kenneth Einar Himma. Cambridge Quarterly of Healthcare Ethics, 9, 275-283 Childress, J. (2001). Putting patients first in organ allocation: An ethical
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