The Ethics of Organ Transplants: The Current Debate

By Arthur L. Caplan; Daniel H. Coelho | Go to book overview
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34. What Transplantation
Can Teach Us about
Health Care Reform

Martin Benjamin, Carl Cohen,
Eugene Grochowski

Organ transplantation has been targeted for elimination or reduction in many proposed schemes of health care reform. 1,2,3 Although recent figures suggest a dramatic increase in cost effectiveness, 4 transplantation is expensive and its exclusion is defended in the name of justice. This is ironic, because no part of the health care system has done more to resolve questions of justice than transplantation. As we try to reform health care, much may be learned from our experience in this area.


In response to the limited supply of organs, the transplantation system has developed fair and efficient principles of allocation. It has dealt with the organ shortage rationally, and for the most part justly. Rationing involves an explicit policy of allocating a limited supply of goods or services according to principles of justice and efficiency. The word is derived from the Latin ratio, for reason or rationality. A system of allocation is rational if it systematically applies defensible principles. It is therefore misleading to say that the present health care system rations "by default." By definition, a system that allocates arbitrarily does not ration; instead, it is probably quite irrational.

The development of rationality in our transplantation system is instructive. At first the system was painfully irrational, marked by organ brokers, offers to sell kidneys, and families pulling strings. Telegenic children

Originally published in The New England Journal of Medicine 330, no. 12 ( March 24, 1994). Copyright © 1994 Massachusetts Medical Society. All rights reserved.


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