Organ Transplants: Assume that there are several people waiting for the same organ. What factors should be used in deciding who gets it?

Actually there are several people waiting for my organ, but I digress. Seriously folks, I would have to say give it to whoever has the best chance of recovering with the thing. No sense in giving it to someone who's probably going to die either way. Also, smokers should go last on the lung list, etc. And this crap with celebrities being put to the top of the list (like Mickey Mantle) is complete BS! I say no celebrity transplants ever! Unless I become one...

The person with the highest chance of recovery and the longest expected life span. I certainly don't want a sixty year old man to get a kidney before a twenty year old woman. Also it should not go to people who did the damage to themselves (i.e. lung transplants for smokers and livers for drinkers). ***Daver: I agree with you on the cost issue, not only in dollar value, but in what those dollars could do for so many other people. This is one of the reasons I am not on the organ donor list.

die the soonest, then waiting time(chances are they will be the same person, but not necessarily), then self inflicted.. they should be at the bottom by default. I realize that people can have problems with an addiction, but I don't have much sympathy. **Daver - I fully expect not to have a heart transplanted. Given an option, I wouldn't accept one. I am fully prepared to keel over dead becasue of my sedentary habits. I know exactly how unhealthy my lifestyle is, I know I enjoy bad foods and no exercise. all things considered, I expected to have keeled over several months ago. I mostly ignore the random pains, which is why I am reluctant to get a physical. I may go out and exercise soon.. my motivation is almost at that point again. and I let Kerry harass me about my eating habits, those have improved marginally.

I'm not really sure what my feelings are on this. That's why I made the survey, of course.
As a preliminary answer: Recovery and waiting longest should come first. Next, I would say the person who will die soonest. I did not pick the self inflicted option, and not because I smoke. The two examples listed are fairly concrete, but there are others which aren't (e.g. heart disease). Lastly, I picked can afford to pay. While it may sound callous, think of this: For the cost of one transplant operation, a hospital could save the lives of many more people. (e.g. by providing free emergency room treatment for those without insurance) I think that it is fine that a hospital spends its charitable monies (if it has any) where it feels it will get the most return in terms of lives saved.
**reality: So if you don't exercise a lot, you should go to the bottom of the list for heart transplants?
**jjg: Oops, that's one I forgot. As a complement to "die soonest without" I should have had "live longest with". It would certainly be a factor in the decision, if I were the one making it.

Mmmmm... da SPLEEEN

The current scheme (who's most desperately in need) is completely backwards. The more desperately they need it, the more likely the operation will fail and the organ will be wasted.

I like triage rules--the person who needs it most urgently of the people who are likely to actually benefit from it--but I would also like to see factored in the self-inflicted injury option. (As a long-time former smoker, I don't feel that I'm entitled to paid-for treatment if I contract a smoking-related illness, nor do I feel entitled to paid-for treatment for any illnesses resulting from my ludicrously high-fat, high-cholesterol diet.)

Who will die soonest w/out it and whose aren't self inflicted

I was appalled by the story about Mickey Mantle getting his third (or so) liver because even after his first transplant he kept drinking like a fish. Talk about throwing good money after bad... I'm in favor of a usefulness metric; who will live the longest and the "best" as a result of getting the organ, and who won't abuse the new organ once they have it. To avoid nasty political machinations, "best" should probably be taken to mean most complete recovery.

Some of these factors are subjective, that is - Who is to say who will die soonest and/or who has the highest chance of survival. Doctors talk like they know, but the truth is it's just probability and it's not always right in individual cases. Giving doctors (or judges?) the ability to choose who is the best candidate, gives them a lot of power over life and death - power corrupts.
...as for Mickey Mantle (and Larry Hagman of the "Dallas" TV show) - that is an interesting point. Should famous and/or important people get special treatment? If we had a great leader who was beloved by the whole country (hard to imagine), would that person deserve to get the first available organ (ahead of all the not so important people)?
Holy Fire by Bruce Sterling (a futuristic novel) has a well-designed future scenario in which there is a gerontocracy (power/money is controlled by old people) because medical techniques have gotten to be very effective at preserving life and the longer you live the more money you acquire. Also (in this book) the people who do healthy things (like never smoking, drinking, or eating unhealthy foods) get the best medical treatment. If you're good, you live the longest.

interesting question ... does anyone know how the receipients are chosen? I feel that the person with the highest chance of recovery should be first ... but I am torn over the person waiting the longest ... we don't know what contributions any of these people will make ... maybe one person could make a significant change in a day, while I couldn't do that in a year ... whole different question.

uh.. If the recipient can't pay for it, and no one else will pay for it (friends, relatives, insurance, charitable foundations, hospital), how does the surgery happen? It's not my primary concern, but I don't understand how people expect it to work. Will the easter bunny perform the operation?

**Bill: What a coincidence. I am currently reading Holy Fire. Just started today.

I'd say waiting the longest. How can you judge who would die the soonest, really? You have some rough idea but what if you bypass someone, and then the next day they get complications and die? That's too hard to decide. Just put people in a line, and when your turn comes, it comes.

high recovery probability, high need, and LOW resources ($)

My first reaction is to say the person who's been waiting the longest, has the best chance of complete recovery. But then i wonder how unselfish I could be if a loved one could live even one more year.

When someone has been on, say, a kidney waiting list for four years to get a kidney, they should come before someone who's only been on there six months. The exception to this would be when the person who has been on there six months has one or two projected moths to live and the person who has been on there four years has around another two or three years to live (if this is possible in kidney situations, I don't know, I'm not a doctor!). Of course then the person who has been on there 6 months should have top priority.

Unfortunately I don't know a hard and fast rule for determining this. I certainly believe that it should go to someone whose injuries are not self inflicted before going to one whose injuries are self inflicted. I think I believe that it should go to a younger person who hasn't lived as much yet. But I also think that it should go to someone less selfish - and how in the world do you measure that?

the way i would choose to do this would be complicated. the first three (waiting, recovery chances, and immediate need) should all be weighed in all cases. chance of recovery should, being an uncertain thing in most cases, probably shouldn't count as much as the other two except in clear cut cases (a 120 year old person with pnemonia or an otherwise healthy 18 year old). in some extreme cases, self inflicted injuries should be considered, if it is likely to happen again. the next three should not matter at all. the last should be the most important of all. if someone donates an organ to be used for a specific person in need, then that person should get the organ, no matter what.

because there is such a limited supply of organs, i think that anyone who receives a transplant should be considered to be "leasing" that organ from the organ pool. they should be required to submit to appropriate restrictions if they wish to continue using said organ (obvious example - if you get a lung transplant, you must agree to stop smoking). if they cannot abide by these restrictions, then give the organ to someone else. the exception here would be if the organ was designated specifically to the patient by the donor. then the patient would "own" the organ.

***jen - hmmm...there might be a game show in there somewhere

I picked "who will die soonest without it", but only if they have a reasonable chance of surviving *with* it.

I DO NOT, repeat, DO NOT, want some white supremacist, neo-nazi, Black panther, or any other form of Supremacy group, white male, or otherwise, to get an ounce of my blood, or one of my organs.

I realize this is an old survey, but I just found it, and it's quite good. My initial response might have been something involving "...whose injuries are not self inflicted," but I didn't choose it for exactly the reasons daver articulated. It's really spooky territory to begin trying to assign blame to illnesses. I can empathise Brian's point about not wanting a Neo-nazi, etc. but I can't support the desire because I also can't support the neo-nazi saying that they do not want a black man to get their blood etc. I think we have to move beyond our prejudices and those of us who can see our own, have to more first. That's the same reason my mother argued successfully in court for the KKK's right to march and protest, even though she hates them. Even the money question is trickier than I thought. I left out money options but then I read davers comments about how hospitals use their charitable $$'s and seth's about the Easter Bunny and got lost again. I think we nee professional, cabinet-level philosophers who specialize in this kind of thinking to make recommendations.

topper: I am taking a Biomedical Ethics course now, and the teacher is a "professional philosopher who specializes in this kind of thinking"... she is on the board of hospitals, and makes recommendations about such cases, after evaluating them ethically. They have a whole complex system in ethics by which decisions are evaluated.

**elijahblue: What criteria would she use in this type of case?

daver: Well, first she would chop the dilemma up into "factual issues", "conceptual issues", and "moral issues". Then she would learn as much factually about the case as she could, identify and define concepts clearly, and identify what the moral questions are. She would then see how the moral questions should be answered based on different moral standards, such as Natural Law, Respect for Persons, Egoism, and Utilitarianism. Then she woud write down this big long argument (case study) stating her reasoning and her conclusions, and any moral rules which might be applicable to future such cases. I can't yet project what her conclusions would be, since we've only had two classes thus far :) ...maybe I will refer to this survey in my class journal.

I am actually researching Organ Transplantation ethics right now, and the factors that go into deciding who gets an organ are blood and tissue typing, urgency of need, time on the waiting list, and geographic distance between donor and recipient. Name, sex, race, and wealth are not considered.