Scarce Goods: Justice, Fairness, and Organ Transplantation

Scarce Goods: Justice, Fairness, and Organ Transplantation

Scarce Goods: Justice, Fairness, and Organ Transplantation

Scarce Goods: Justice, Fairness, and Organ Transplantation

Synopsis

We call it lifeboat ethics: When there is not enough of this or that scarce good, who should die that others might survive? Born in the 19th century, when shipwrecks were frequent and lifeboats scarce, it has become a 21st century dilemma. Who should get the last hospital bed, the scarce medical drug, the limited educational doctor, the needed transplantable human heart? Tom Koch considers both lifeboat ethics and its modern application to the distribution of transplantable human organs in the United States. He shows that the scarcity of organs is exacerbated where not created by racial and regional inequalities inherent in the American health care and transplant system. The real question, he concludes, is not "who should die" when there is not enough to go around, but the reasons why scarcity pervades at all.

Excerpt

In 1998 the secretary of the U.S. Department of Health and Human Services (DHHS), Donna Shalala, announced changes in the way transplantable human organs were to be distributed. In a letter to the U.S. Congress she argued that inequities in the distributive system developed in the 1980s by the United Network for Organ Sharing (UNOS) made these changes necessary. “In some areas of our Nation,” she lamented, “patients wait 5 times longer or more for an organ than in other areas.” The result of such regional inequities was that “patients die in areas where waiting times are long, while at the same time organs are being made available to less ill patients in areas with shorter waiting times.”

Shalala proposed changing the nation’s regionalized system of organ distribution into one that was truly national, one in which no potential organ recipient would be disadvantaged by location. UNOS, an independent agency created to supervise organ collection and distribution under DHHS supervision, protested what became known as Shalala’s “Final Rule.” UNOS officials warned that moving from a regional to a national system of organ distribution would both disadvantage smaller transplant centers and adversely affect already chronically low rates of organ donation around the nation.

The question seemed clear enough: Will a national or a regional system best serve in the distribution of perishable human organs suitable for transplantation? This is a type of problem that geographers (and oper-

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.