Ethical Questions Around Transplanted Organ Distribution
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Doctors in surgery

Worldwide, over 100,000 people receive life-saving organ transplants every year. Unfortunately, many people still die while awaiting transplant. In the United States, 17 people awaiting transplant die each day. In the United Kingdom, 470 people awaiting transplant died in the year between April 2020 to March 2021. Over 1,300 people on the Eurotransplant waiting list died awaiting organs in 2021. 

Because of the shortage of organs, societies use a variety of strategies to encourage citizens to become organ donors. Unfortunately, not everyone wants to be an organ donor and others are not eligible to be organ donors because of age or health status. While the majority of people in most nations support organ donation, many people choose NOT to donate because of mistrust in the medical field, misunderstandings about what is meant by “brain death,” or religious or cultural beliefs. The shortage of organs to transplant means that decisions must be made about who will receive an organ when it becomes available. In this blog post, we’re going to explore how these decisions are made. 

Determining Who Is Worthy
How do medical professionals decide who gets an organ after it becomes available? In most countries (e.g., U.S., U.K., Germany, Australia), strict criteria exist to decide who will ultimately receive an available organ; some criteria are objective and easy to assess (e.g., blood type and organ size), whereas others lie in an ethical quagmire that require people to use their own judgment by asking themselves the question: Who is worthy of receiving an organ transplant?

Recently, a case bubbled to the top of many people’s news feeds—David Bennett Sr. received a genetically modified pig heart after being denied a human heart. While much of the attention focused on the fact that he had received a pig heart, the reasons that Bennett was denied a human organ are equally interesting and thought-provoking. Some news coverage suggested that his conditions—advanced heart failure and an irregular heartbeat—made him ineligible for a new human heart. Another justification came from his son who claimed that because he did not manage his health properly, doctors felt that his non-compliance should preclude him from receiving a human heart. The debate about his “worthiness” continued after the transplant surgery, when it was reported that Bennett had been incarcerated in the 1980s for stabbing a man. This case brought to the fore the complex decision-making process involved in allocating organs for transplant. Since then, news stories (and rancorous public discussion) have focused on individuals all over the world being removed from transplant waiting lists because they have refused COVID-19 vaccines. So, what IS fair when considering who receives an organ transplant? 


In the Classroom
Examining the notion of fairness in the allocation of organs for transplant can serve as a powerful hook to motivate young people to consider medical ethics (and to apply logical thinking). A great way to spark classroom discussion could be to share a news article about David Bennett or about organ denials based on vaccine status and then pose the following questions (based on Ethics of Organ Transplantation from the University of Minnesota’s Center for Bioethics):

  • Should someone who has received one organ transplant be given a second transplant? Or should people who have not had a transplant be given priority over those who have already had one?
  • Should people whose lifestyle choices (smoking, drinking, drug use, obesity, etc.) have damaged their organs be given a chance at an organ transplant?
  • Should suicidal individuals be given an organ transplant? What if they attempted suicide in the past but are not currently contemplating suicide?
  • Should people who have young children be given an organ transplant over a childfree person? over an elderly person? Should parental status and age matter?
  • Should people who can’t afford expensive anti-rejection drugs be passed over for a transplant?
  • Should people who don’t have insurance and can’t pay for a transplant be allowed to go on the national waiting list? 
  • Should condemned prisoners receive organ transplants? What if they are serving a life sentence without parole?

Remember, it is important to establish rules about how to engage in a respectful debate. To ensure a productive discussion, 3 Steps to Civil Discourse in the Classroom from the National Council for Social Studies is a great place to start. It is a primer for setting up a debate in the classroom, especially how to navigate potentially sensitive topics and topics that have the possibility of inequity or unintended consequences.

Explore these resources to investigate organ transplantation and the ethics of organ transplantation further:

  • In this LabXchange interactive, users can select the criteria they think are used in the U.S. to determine whether to add a patient to the organ transplant waiting list.
  • This episode of the Rawtalk podcast explores organ donation in Canada, the ethics of organ donation, and the stories of some transplant recipients.
  • This episode of the No Easy Answers in Bioethics podcast explores various models for organ donation around the world. 

For additional information about organ donation, read this ABE article, Changing Organ Donation Using Biotechnology.
 

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