Organ Transplant: Who gets them and who doesn’t?

Organ Transplant
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Organ Transplant
Organ transplantation is a life-saving medical intervention that has been linked to several positive outcomes. According to Vanholder et al. (2021), organ transplantation not only increases the survival rates of patients with organ failure but also enhances their quality of life. Given these benefits, many countries have put in place different mechanisms to guide the allocation of organ transplants. However, the demand for organ transplants is high, and the number of successfully performed transplants is low, which causes a lot of patients to stay on the waiting list for too long. For instance, in the United States (US), there is a significant gap between the demand for organ transplants and successful organ transplants. The number of viable organs outweighs the number of organ recipients on the waiting list (National Academies 2017). Determining who gets organ transplants and who does not can be a complicated endeavor, and as such, it is important to examine the ethical issues associated with the allocation of organ transplants. This paper explores the ethical challenges in organ transplants with a special focus on the guidelines and factors influencing the allocation of organ transplants to patients on the waiting list.
Ethical Challenges of Organ Transplant
Organ transplantation poses several ethical challenges for physicians and patients because it requires one person, deceased or alive, to voluntarily donate their organs to save another person’s life. Below are some of the ethical challenges associated with organ transplantation and allocation.
Equity, Justice, and Fairness
Given the high demand for organs and the shortage of viable organs, healthcare professionals have to determine who gets an organ transplant and who does not. While allocating organ transplants to patients, the transplant community has to create a balance between equity and utility while allocating scarce donor organs (Nadim et al., 2017). The community has to also maintain the effectiveness of the donor organs in saving lives. Organ transplantation raises the ethical concern of justice and fairness. According to Howard and Cornell (2016), transplant centers face the ethical issue of fairly allocating the few organs to a large number of patients on transplant waiting lists who could die due to a lack of a donor organ. Also, the ethical issue of how to place patients on the waiting list so that organs are allocated appropriately to save more lives arises.
To address the ethical challenge of allocation and placement and enhance justice and fairness, the transplant community has been provided with global, national, and local guidelines. At the global level, the World Health Organization (WHO) has developed some general guidelines that can be used to facilitate equality, justice, and fairness. One of the WHO’s guidelines is the distributive justice and equity guideline, which indicates that donor organs should be allocated to patients based on medical need, and other considerations, such as financial considerations, should be ignored (Navin et al., 2018). This guideline ensures that allocation is not based on socio-economic background or other factors that contribute to inequity. Patients are given priority based on the status of their health. Nadim et al. (2017) refer to this approach in organ transplant allocation as the need-based approach. This approach gives priority to patients facing the greatest risk of mortality. Another of WHOs guidelines states that there should be transparency in how organs are donated and transplanted to scrutinize the process (Navin et al., 2018). The guideline also requires the transplant community to enhance transparency while protecting the privacy and anonymity of donors and recipients. This guideline facilitates the fair allocation of donor organs because everything is done in the open, leaving no room for people to use unfair means in the allocation process.
At national levels, equitable and fair allocation of donor organs in countries such as Canada and the US is guided by basic ethical principles. These ethical principles include:
* Utility- The ethical principle of utility requires that the allocation of organs should be such that it maximizes the net good expected from the transplantation (Organ Procurement and Transplantation Network (OPTN), 2015; Canadian Blood Services (CBS), 2015). Thus, in the allocation of organs, the good of the transplantation should outweigh the harm. This principle encompasses the biomedical principles of non-maleficence and beneficence. According to OPTN (2015), while using this principle in the allocation of organs, certain factors, such as the social status, gender, and race of the recipient, should not be considered, nor should the transplant outcomes of a particular social group. There should be an individual assessment of patients to ensure equity in the allocation of organs. When the allocation of organs is not dependent on social status, race, and gender, among other factors that contribute to social inequities, patients are more likely to fairly and justly receive organ transplants.
* Justice- While the principle of utility focuses on the net good of the allocation and transplantation, the justice principle focuses on fairness in allocating the organs to potential recipients (OPTN, 2015; CBS, 2015). Looking at the medical benefits of a transplant, such as the patients’ survival and quality of life, may not be enough or even morally right, according to OPTN (2015). This is why the principle of justice is important because it looks beyond the medical good and into the medical needs of patients. For instance, the patient with the greatest risk of mortality will be given priority over other patients with less risk even if the medical outcomes will be better among these other patients. This principle is in line with the WHO’s need-based guidelines (Navin et al., 2018). Factors that are considered in the justice principle include the seriousness of the patient’s condition, age, amount of time on the waiting list, geographic fairness, whether the patient has had the same transplantation before, and the future probability of getting a suitable organ (OPTN, 2015). This ensures that every patient is treated fairly and ethically in the allocation process.
* Respect for persons- Beyond the medical factors, it is also important to treat recipients with dignity. Respect for persons, which also integrates the biomedical ethical principle of respect for autonomy, requires treating people as individuals with rights and decision-making capabilities (OPTN, 2015). The decisions of recipients and donors should be respected. In this ethical principle, the transplant community should consider factors such as the recipient’s right to refuse an organ, free exchanges of organs among autonomous individuals, and transparency in the allocation and transplantation processes (OPTN, 2015). This last factor is also in line with the WHOs guideline that encourages transparency to allow for open scrutiny of the processes (Navin et al., 2018). This ultimately enhances accountability in the allocation of organs (CBS, 2015) and can eliminate injustices.
Allocation and Acceptability of Compromised Organs
Another ethical challenge that the transplant community faces is allocating and accepting a compromised donor organ for transplant. As revealed by Howard and Cornell (2016), part of deciding who gets an organ also involves deciding the acceptance criteria for the donor organ. It is expected that transplants should be done with organs that are ideal and functional. However, sometimes, the need to allocate a much-needed transplant organ and carry out transplantation may lead to the transplantation of a less than ideal organ (Howard & Cornell, 2016). There are no stringent guidelines on the acceptability of an organ for transplant, and different transplant centers use different cri...