The Ethics of Organ Transplants: The Current Debate

Arthur L. Caplan

In the past few years there has been a dramatic rise in the demand for organs for transplantation. Advances in surgical techniques, tissue typing, and the development of powerful immunosuppressive drugs, such as cyclosporine, have made it possible to transplant both a larger number and an increasing variety of organs. Among organs and tissues currently being transplanted from cadavers are kidneys, hearts, lungs, livers, bone marrow, skin, corneas, and pancreases.

Although some of these procedures are still experimental, graft and recipient survival rates for transplantations have shown steady improvement during the past decade. ^1,2 Many centers report five-year-graft survival rates of 60 percent among patients who have received kidneys from cadavers. More then 95 percent of those who receive corneas from cadavers have their sight restored. Moreover, recent survival rates for heart transplantation are approaching 50 percent at five years.

This remarkable progress in the field of organ transplantation raises numerous moral and policy problems for the medical profession and the general public. Who ought to pay the high costs associated with these procedures? What rate of survival justifies the labeling of a procedure as therapeutic, and who should be responsible for making such determinations? When the number of organs is insufficient to meet the demand, what policies should be instituted to help increase the availability of these precious tissues?

It is the last question that, in many ways, is the most disturbing of all. The large gap that exists between the available supply and the demand for

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