Ethics of organ transplantation

Distribution

Scarcity of replacement organs, currently only from living or dead organ donors rather than factories, and insufficient for demand, results in a growing waiting list of patients and ethical issues in allocation. In 1994, E. H. Kluge objected to the equal access principle based on his argument that people whose need are uncontrollable should be preferred over people who choose a poor lifestyle. Donor matching intended to optimize life-years gained is also subject to debate, as people value their organ and the remainder of their lives differently. In practice, organ and tissue banks often choose patients in ways that secure their revenue, whereas “altruistic” clinics may not have the income necessary to fund their own needs, let alone to support research and development to improve quality and availability of care

People with intellectual disabilities have historically been excluded from organ transplantation waitlists. A 1993 study by Levenson and Olbrisch found transplant centers were more likely to exclude people with intellectual disabilities from certain types of organ transplants (i.e. heart, liver, and kidney) and if they had more severe intellectual disability compared to those with more moderate intellectual disability. Current commentary on the ethics or organ distribution opposes the absolute exclusion and encourages an individualized interdisciplinary assessment.