Organ Allocation

Organ transplant

1.     A medical procedure in which an organ is removed from one body and placed in the body of a recipient to replace a damaged or missing organ.  

2.     Donors can be living or dead. Living ones are mostly given to relatives or friends.  

3.     Organs that have been successfully transplanted include heart, kidneys, and liver. Tissues include bones and skin. Kidneys are the most commonly transplanted organs.  

4.     Organs must be put into the recipient quickly, and so location is a factor on who the recipient is.  

5.     There is a shortage of organs available in the UK, with 3 people a day dying on the waiting list. The UK is seeing an increase in transplants because of a policy change to a system of presumed consent.  

6.     A majority of people agree it’s a kind and loving thing to do, and so there is much support for it.  

 

Organ allocation

1.     The process of determining how organs are allocated.

2.     Medical need drives allocation decisions. This is coupled with information such as blood group, age and size to get the best possible match.

3.     Geography plays a part as time out of the body needs to be minimal.  

4.     In some countries, age, lifestyle, ability to pay are also factors. Payment is not allowed in the UK under Human Tissue Act (Scotland) 2006.

5.     In the UK, patients are placed on the National Transplant Database, and an evidence-based computer algorithm program is used to identify the best matched patient or department.   

6.     Rules for allocating organs are determined by the medical profession in consultation with other health professionals, and the system is regulated by the Human Tissue Authority (HTA).

7.     You can’t be on the Transplant list in the UK and somewhere else at the same time. 

Lancaster boy - William

He is being kept alive by dialysis, but it will stop working in 12 months most whereas if he wasn't kept alive by it, he would survive for a couple of weeks.

There is a 50% survival rate, with doctors saying a recurrence will be 100%.

His mother wants him a kidney transplant, thus launching a legal case and an appeal for possible donors to come forward.

If the transplant proved successful, William would live a further 15-20 years before he needed another one.

Steve Jobs

Received a liver transplant in 2009.

He chose to travel to Tennessee because the supply and demand for organs was more favourable there than in California.

He is wealthy, and many questions have been raised on how the rich can access organs.

The waiting list in Tennessee is 3x shorter than in California.

It's expensive, and you must show up for an extensive in-person evaluation, where you have to be available for a transplant in the area within hours of an organ becoming available.

There were roughly 16,000 people on the national liver waiting list when Jobs got a liver. He was one of 1,581 people who got livers in the United States in the first quarter of [2009]

If his tumour had spread from his pancreas into his liver, some transplant surgeons say that they would not recommend a liver transplant because no data shows a transplant will stop or even slow the spread of the cancer.

LMB

·       Database: All patients who are waiting for transplants are registered on the National Transplant Database.

·       Rules for allocating organs are determined by the medical profession in consultation with other health professionals, the Department of Health and specialist advisory groups. The system is regulated.

·       Computer: An evidence-based computer algorithm program is used to identify the best-matched patient or department.

·       There should not be any discrimination based on age, lifestyle or perceived merit. The ability to pay is irrelevant, too because no money can be transferred, and it does not have an effect on when you get allocated one.

·       Match: The blood group, age (child vs adult) and size of both the donor and recipient are all taken into account to ensure the best possible match for each patient.

·       Children: Organs donated from children generally go to child patients to ensure the best match in size but when there are no suitable child recipients, organs from young people are given to adults. Children are at the top of the priority list for kidney transplants because they do not respond as well to dialysis.

·       Location: The location of the donor and recipient is also considered to minimise the delay between retrieving and transplanting organs.

·       Time: Waiting time from the earliest of start of dialysis or activation on the list (favouring patients who have waited longest) is also a factor.

·       Lifestyle: Sometimes, lifestyle can come into play here too, where patients have to meet certain lifestyle criteria like weight loss or giving up smoking to qualify for a transplant.

 

This is what the NHS transplant people say about lifestyle:

The decision whether or not to register a patient on the transplant list will be made after discussion with the patient and other relevant healthcare professionals, including anaesthetists, transplant coordinators and psychiatrists. The patient’s family and partner usually will be involved as patients find that helpful, and the family’s support is likely to improve the eventual outcome. Other factors which will need to be considered will include the reason which gave rise to the primary cause of liver failure (for example, alcohol-induced liver diseases), a history of illegal drug use or self-inflicted; medical or psychiatric conditions; and the patient’s age.

 

Moral Issues

·       General: the value of life

·       the sanctity of life

·       The role of age and circumstances/ ageism

·       equality

·       practical difficulties - location

·       personal responsibility for health

Overall Christian perspective

The Bible encourages people to support the poor and needy. There are many examples of Jesus doing so. ‘Heal the sick, raise the dead, cleanse those who have leprosy, drive out demons. Freely you have received; freely you give.’ Matthew 10:8

This suggests that healing is a positive thing and life and health should be good aims for Christians.

It is highly discriminatory to refuse to treat someone on the grounds of age, illness, or disability, and note that Jesus chose to spend time with vulnerable and marginalised people – he did not discriminate.

The Sanctity of Life principle means that they are strongly in favour of the principle of equity in organ allocation.

This is especially true when compared to the alternative: QALY’s – what are they? Why are they controversial? Who would benefit from a QALY-based system rather than an equity-based system?

Having said all this, staying alive is not always the main aim in a faith that believes strongly in an afterlife free from pain. While in most cases trying to preserve life is a high moral good, many Christians acknowledge that the choice not to participate in further treatment such as a new organ can be equally valid.

Age

Some would say that the older a person is, the less deserving they are because they have yet to live their lives whilst older people already have. Older people have given their all to society whilst younger people still have to give so it makes sense that those who have more to give should receive priority. Of course both of these could work the other way in that young people will not miss what they do not know whilst old people will so they should get priority. Secondly, old people have paid their debt to society and should therefore be entitled to more. Young people have yet to pay their debt to society so should get no return as yet. A Christian would say that we should protect the vulnerable which are arguably those who are older, and one of the 10 commandments is ‘Honour your mother and father’ which when applied here suggests older people who have given a lot (by birthing you, or helping to create the society you are in) are owed gratitude for creating the society we have today. If everyone is equal in the eyes of God discrimination based on age is wrong. We all have the right to live.

 

Merit

Should a person’s need for a transplant be based on their past achievements, their role in the community, their future potential.

We already know that it is a factor in deciding who gets a liver transplant in the UK. Patients whose organs are damaged through some form of drug or alcohol abuse are considered suitable or unsuitable depending on their prospects of controlling the substances that led to the organ damage in the first place. In the UK patients who have self inflicted organ damage are assessed on their ability to gain maximum benefit from the transplant. Although framed in medical terms, the decision is essentially a judgement on the sincerity and determination of the patient to overcome their addiction.

Christians would return to the fact that humans are equal in the eyes of God. Some may refer to the fact that life is a gift from God, and we are to be stewards of all that has been gifted to us. This is commonly interpreted as creation such as the land and animals, but could easily include our bodies. The Bible says ‘your body is a temple of the holy spirit.’ This could be used to imply that as well as all life being sacred, people should look after their bodies. We see that when God gave instruction to Adam and Eve about how to behave in the Garden of Eden and they didn’t behave in that way, but just ignored it they were punished. From this, stricter more traditional Christians may say that humans have a duty to follow God’s commands and if they don’t they can expect punishment, and so a system based on merit is not too out of line/out of sync with punishing them in the Garden.

Allocation on the grounds of merit also has implications for personal autonomy. If an individual chooses to live a high risk lifestyle then, because their life is their own to lead they should be entitled to do that. An obese person might decide that the risk they want to run is a beer and bun-filled of a high fat diet. That is their choice, they want to take the risk because bear and buns for them are just the business. The mountaineer who solos extreme climbs is also making a lifestyle choice. True, it may not involve the need for a transplant but she may well be seen as being someone who is entitled to major healthcare without any judgement should something in her lifestyle cause her to require hospital treatment.

From a Christian perspective, free will is a God given gift that humans should be able to enjoy. Some would disagree that this allows them to just do what they want with their bodies because with free will comes direction in the form of the Bible (see above re: temple of the HS etc).

Stan Reisler writing in 1987 did not want to see doctors put in a position where they would become “courtroom judges in whom patients could not confide for fear of reprisals.” (reprisal: fear of attack/judgement/changing an outcome).

Cost

In the UK, the NHSBT says transplants are cost-effective, not expensive.

• Dialysis: £31,000 per year

• Transplant maintenance: £24,000 per year
  This saves money across thousands of patients.

Access to Transplants in the UK:

• Private patients do not jump the queue.

• Going private only affects where you get treated, not when.

In Other Countries (e.g., USA):

• No NHS – people need health insurance.

• Transplants cost extra, so better care often goes to the wealthy.

• This creates inequality in access.

Example – Steve Jobs (2009):

• Got a liver transplant in Tennessee, far from home.

• Likely registered at multiple centers (legal, but costly).

• Only the rich can afford this—seen as a "loophole" for the wealthy.

Global Issues:

• India, China, Brazil: Reports of illegal organ trading.

• In China, some organs came from executed prisoners (with consent).

Christian Views on Fair Access:

1. Sanctity of Life – All are made in God’s image (Genesis 1:27).

2. Justice & Fairness – Treat everyone equally (Micah 6:8).

3. Compassion for the Poor – Jesus cared for the vulnerable (Luke 4:18).

4. Stewardship – Organs are a gift to be shared fairly.

Humanism

Core Belief: Respect for the dignity of all individuals

Quote (Humanists UK):
"Decisions should be made on the basis of medical need, urgency, and likely success—not other factors."

Key Ethical Principles

Equality & Fairness

• Equal access for all, regardless of age, wealth, or social status.

• Everyone has inherent worth and deserves a fair chance at life.

• Potential issue: Only focusing on medical need might ignore wider circumstances (e.g. if someone has dependents).

Beneficence & Non-maleficence

• Aim to save the most lives and reduce harm and suffering.

• A system focused on benefits could improve outcomes and encourage more donations.

Transparency & Accountability

• Allocation decisions should follow clear, unbiased rules.

• Builds trust between the public, patients, and healthcare system.

• Example: In Brazil, illegal organ scandals reduced trust and donation rates, making people turn to dialysis instead.

Community Engagement

• Involves a wide range of people (medical experts, public, patients) in decisions.

• Encourages fairness, prevents domination by wealthy or powerful groups.

• Matches Humanist values of inclusivity and equal worth.

Evaluation Points

Positives:

• Promotes fairness, empathy, and public trust.

• May lead to better outcomes and more organ donations.

Negatives:

• Compassion-based decisions may lack clear criteria.

• Could result in inconsistent or subjective allocation choices.

Act Utilitarianism

Act Utilitarianism (Jeremy Bentham)

Core Principle: "The greatest happiness for the greatest number"
Goal: Maximise pleasure, minimise pain.
Type of Theory:

• Teleological – judges actions by end result.

• Relative – considers each situation individually.

• Consequential – outcome determines morality.

Bentham’s Hedonic Calculus: Used to measure the pleasure/pain an action produces.

1. IDCE

Act Utilitarianism – Evaluation

Positives:

1. Maximises benefit – Focuses on helping the greatest number.

2. Flexible – Considers individual situations and needs.

3. Inclusive – Looks at medical, personal, and social outcomes.

4. Evidence-based – Encourages using clinical data for fair decisions.

5. Drives progress – Can improve systems through reflection and feedback.

Negatives:

1. Individual rights risk – May override personal choice for greater good.

2. Unpredictable – Can lead to uncertainty in decision-making.

3. Risk of exploitation – Marginalised people may lose out.

4. Measuring utility is hard – Happiness is subjective and complex.

5. Short-term focus – Might ignore long-term or societal effects.

6. Bias risk – Unfair to judge someone’s worth by lifestyle or social ties (e.g. introverted, child-free people).

Libertarianism

Core Belief: Maximize individual freedom and minimize state control.
Philosophy: Emphasizes autonomy, personal responsibility, and free-market economics.
Opposed to government interference in personal choices, including healthcare.

Key Libertarian Principles (Applied to Organ Donation)

1. Personal Responsibility

   • Individuals should manage their own health (e.g., not rely on the state if they damage their organs through poor choices).

   • State healthcare creates dependency.

2. Individual Autonomy

   • Freedom to choose whether to donate or receive an organ.

   • Government should not interfere with organ allocation decisions—this should be left to individuals and medical professionals.

3. Property Rights

   • Organs are part of your body, and you have the right to control or sell them as personal property.

   • Donation should always be voluntary.

4. Free Market Principles

   • Organs should be allocated via supply and demand.

   • Buying/selling organs respects autonomy and can increase availability.

   • If you can afford it, you can buy it—market logic.

Quotes from Ayn Rand (Objectivist Philosopher, linked to Libertarianism):

• “The smallest minority on earth is the individual.”

• “Individual rights are not subject to a public vote...”

• Rand rejected altruism and championed egoism.

Real-World Example: Incentives in Israel & Singapore

• Israel (2010): Prioritises people on transplant list if they or relatives have signed donor cards.

• Result: Increase in donations.

• Criticism: Prioritising based on registration unfairly favours people with large families and ignores clinical need.

Evaluation – LibertarianismPositives:

1. Individual Autonomy:

   • Respects personal freedom in health decisions.

   • People choose for themselves based on values and preferences.

2. Increased Organ Supply:

   • Market incentives may encourage more donations.

   • Selling organs could save more lives.

3. Shorter Waiting Times:

   • More supply = quicker access for patients.

   • Could ease suffering for patients and families.

4. Efficiency and Innovation:

   • Competition and market forces may drive improvements in organ allocation systems and transplant technologies.

5. Promotes Responsibility:

   • Encourages people to stay healthy to avoid needing a transplant.

   • Shifts focus from dependency to personal care.

Negatives:

1. Lack of Equity:

   • Wealthier people have better access to organs.

   • Marginalised groups could be left behind.

2. Commercialisation:

   • Treats organs as products—may lead to ethical concerns like exploitation and inequality.

3. Lack of Regulation:

   • Could result in organ trafficking and exploitation.

   • Patient safety and ethics at risk.

4. Loss of Trust in Healthcare:

   • Public may view system as unfair.

   • Could reduce willingness to donate (fear of “selling organs to the highest bidder”).

5. False Equivalence (iPhone Analogy):

   • In markets, fake goods like iPhones are annoying—not life-threatening.

   • A fake or bad organ transplant can kill.

6. Body ≠ Commodity:

   • Unlike groceries or gadgets, body parts aren’t replaceable.

   • The right to life is protected under the Universal Declaration of Human Rights (UNDHR)—not a market product.