Limited organ supply raises allocation concerns

Ethics Forum. July 1, 2002.

Scenario: Should a prisoner get a life-saving heart transplant?

A case in California earlier this year sparked a nationwide debate regarding organ transplants for prison inmates. We asked two medical ethicists to address the ethical concerns. One author specifically was asked to address the arguments in favor of such procedures, while the other was asked to discuss the arguments against providing inmates with organ transplants.

Reply:

In favor. There are more than 80,000 people on the waiting list for an organ transplant in the United States. Nearly 6,000 of them will die this year before a transplant becomes available.

The chronic shortage of donor organs gives rise to challenging and tragic issues related to recipient selection and organ allocation.

The recent case of a California prison inmate receiving a heart transplant has generated considerable discussion and debate regarding the propriety of an inmate receiving a life-saving transplant.

First, it is important to understand two separate but related processes: organ recipient selection and organ allocation.

Recipient selection refers to the decision by a transplant center to register an individual on the waiting list after completing an evaluation. (Individual transplant programs have tremendous latitude to develop their own policies and protocols for patient evaluation and recipient selection.)

Organ allocation refers to the identification of the actual recipients when organs have been recovered from a particular donor. (These decisions are determined according to organ allocation algorithms, based on policies that have been developed by the United Network for Organ Sharing, which operates the national Organ Procurement and Transplantation Network under a contract with the Dept. of Health and Human Services.) [...]