Changing Priorities in Organ Transplants
As the number of patients waiting for kidney transplants rises, the network overseeing how donated kidneys are allocated is considering changes. Currently, those longest on the waitlist usually have priority, but age could soon be a factor, with younger patients favored in some cases. We explore the ethical and medical factors in the debate.
Guests
Associate Professor of Surgery at Ohio State University; Chair of the United Network for Organ Sharing (UNOS) Kidney Committee.
Professor of Medical Ethics at the Kennedy Institute of Ethics; Professor of Philosophy at Georgetown University; Board of Directors of the Washington Regional Transplant Community; United Network for Organ Sharing (UNOS) Ethics Committee
Former president of the National Kidney Foundation; Senior Associate Dean for Clinical Affairs at the University of Illinois at Chicago
Transplant Nephrologist, Carolinas Medical Center, Charlotte, North Carolina
Comments
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Great topic! Just as time on waiting list is used today to help determine who receives an organ, time on willing donor list should also be a factor.
Please check out the article "Using Reciprocity To Motivate Organ Donations" from the Yale Journal of Health Policy, Law and Ethics.
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=459002
or
http://www.lifesharers.org/articles/nadel.pdf
Thanks!
Carolina
I found Dr. Veach's comment on giving organs to those who are donors as opposed to those who refuse to donate as problimatical. He said I believe:
"Everyone donates and everyone recieves organs"
That ethical princple would be good if it were true. Everyone does NOT donate, As a matter of fact, there are large segments of the American population what does NOT donate for various reasons.
How is it ethical to give organs for transplant to people who refuse to doneate to others, THat seems to me totally unethical.
Others on the program suggested that donation status might be "a factor", but why should it only be a factor. It should be a determining factor unless there is a surplus of organs and there are no matching recepients who are donors.
There are ethical exceptions. There are children and people whose mental condition limits their ability to give their informed consent. I have no problem of treating them as donors UNTIL they can make decisions of their own. FOr example, when youngsters get their drivers licences, they can or cannot become donors. If they have a ,icence and choose NOT to become donors, they should be in the second teir priority who get an organ only if there is NOONE in the first tier--the Israeli Method.
These "complexities" should not interfere with a change in the existing system. Virtually every day, A person who has been a donor throughought his/her life dies for lack of a donated organ yet an organ is given to a person who would not under any circumstances allow his organs to be used to save anyone else.
NOTHING CAN BE LESS MORAL OR ETHICAL THAN NOT CHANGING THIS.
One concern in implementing this ethical requirement is that some relgious beliefs and cultural customs inhibit some people from being organ donors. If they practice their religion or tradition, the are precluded from recieveing a donated organ unless there are no others whare are donors. However, Israel, a Jewish state, has after extensive ethcial and religious consideration, decided that while there are cultural and religious choices that one should be free to make, there are consequences to these choices. For that subset of orthodox Jews who believe in intact burial, they have that right. But they do not have the moral and ethical right to recieve organs when they would never give them.
The most important reason however, that this policy should be adopted is precicely to INCREASE the number of organ donors. There is no religion where there is an abolute theorlogical prohubution against organ donation. There are subgroups, cults and cultures who have traditions and some believes prohibiting this. When faced with the consequences of no likely chance of organ availabity of they should need it, many will reconsider and change their mind. But there is NO COST to being selfish and/or maintaining a vague tradition, if they can withould help to anyone else and yet be assured of an equal chance to obtain an organ if they need it.
I found Dr. Veach's comment on giving organs to those who are donors as opposed to those who refuse to donate as problimatical. He said I believe:
"Everyone donates and everyone recieves organs"
That ethical princple would be good if it were true. Everyone does NOT donate, As a matter of fact, there are large segments of the American population what does NOT donate for various reasons.
How is it ethical to give organs for transplant to people who refuse to doneate to others, THat seems to me totally unethical.
Others on the program suggested that donation status might be "a factor", but why should it only be a factor. It should be a determining factor unless there is a surplus of organs and there are no matching recepients who are donors.
There are ethical exceptions. There are children and people whose mental condition limits their ability to give their informed consent. I have no problem of treating them as donors UNTIL they can make decisions of their own. FOr example, when youngsters get their drivers licences, they can or cannot become donors. If they have a ,icence and choose NOT to become donors, they should be in the second teir priority who get an organ only if there is NOONE in the first tier--the Israeli Method.
These "complexities" should not interfere with a change in the existing system. Virtually every day, A person who has been a donor throughought his/her life dies for lack of a donated organ yet an organ is given to a person who would not under any circumstances allow his organs to be used to save anyone else.
NOTHING CAN BE LESS MORAL OR ETHICAL THAN NOT CHANGING THIS.
One concern in implementing this ethical requirement is that some relgious beliefs and cultural customs inhibit some people from being organ donors. If they practice their religion or tradition, the are precluded from recieveing a donated organ unless there are no others whare are donors. However, Israel, a Jewish state, has after extensive ethcial and religious consideration, decided that while there are cultural and religious choices that one should be free to make, there are consequences to these choices. For that subset of orthodox Jews who believe in intact burial, they have that right. But they do not have the moral and ethical right to recieve organs when they would never give them.
The most important reason however, that this policy should be adopted is precicely to INCREASE the number of organ donors. There is no religion where there is an abolute theorlogical prohubution against organ donation. There are subgroups, cults and cultures who have traditions and some believes prohibiting this. When faced with the consequences of no likely chance of organ availabity of they should need it, many will reconsider and change their mind. But there is NO COST to being selfish and/or maintaining a vague tradition, if they can withould help to anyone else and yet be assured of an equal chance to obtain an organ if they need it.