PHLB09H3 Chap.5 Justice, Organ Payment and Transplant Priority
Justice, Organ Payment and Transplant Priority
Two questions about scarce organs
Week six asks how scarce organs should be allocated and whether people should be paid to provide them. Allhoff examines whether patients with alcohol-related liver disease should be ranked lower for transplantation, and Friedman argues that living organ donors should be paid under government regulation.
A news report about a woman denied a liver transplant over alcohol use and a podcast on what money can buy round out the week.
Allhoff's two routes
On medical grounds, Allhoff finds no case for a group penalty: abstinent patients are not riskier as a class, and a lower group average life expectancy does not justify judging an individual by it.
The moral route depends on blame, and blame depends on whether drinking is chosen. Accept a disease concept of alcoholism and deprioritisation fails; reject it and it may be legitimate.
Friedman's case for payment
Friedman points to a growing shortage, an existing black market and the unfairness of a system in which everyone benefits except the donor.
Because society already pays people for risky uses of their bodies, including research participation, she argues that a regulated, uniform fee for living donors would be safer and fairer.
What this chapter covers
- 01
Triage and Expected Benefit
- 02
Likelihood of Success
- 03
Group Averages and Individuals
- 04
Disease Concept of Alcoholism
- 05
Paid Living Donation
- 06
Exploitation Objection
Worked example · free
Test a blame-based allocation rule
- 2Assess the rule against likelihood of success and life expectancy.
- 2Identify the moral premise the rule depends on.
- 2Explain how the disease concept bears on that premise.
Key terms
- Triage
- Triage is the allocation of scarce medical resources to where they will do the most good, judged by expected success and benefit.
- Disease Concept of Alcoholism
- The disease concept of alcoholism is the view that an alcoholic does not choose to drink, either after starting or from the outset.
- Valuable Consideration
- Valuable consideration is the legal term for payment or other benefit, which living organ donors may not receive under the law Friedman criticises.
Justice, Organ Payment and Transplant Priority FAQ
Does Allhoff think alcoholics should be deprioritised for liver transplants?
Not on medical grounds. Abstinent patients are no riskier as a class, and individual comorbidities rather than alcoholism determine expected benefit. Morally, he says the answer depends on whether alcoholics are responsible for drinking: if alcoholism is a disease, deprioritisation is unjustified, and if it is not, a blame-based ranking might be legitimate.
What is the homeowner analogy?
Allhoff imagines two homeowners whose houses are destroyed, one by his own fire and one by a tornado. Many people think aid should go first to the tornado victim, who bears no blame. The analogy supports deprioritising alcoholics only if they chose to drink, which is exactly what the disease concept of alcoholism denies.
Why does Friedman compare organ donation with paid research?
She argues that society already pays research volunteers to accept physical risks, and permits payment for blood, eggs, sperm and surrogacy. If those payments are acceptable, it is inconsistent to forbid a regulated payment to living kidney donors, who accept a comparable kind of risk while everyone else involved in the transplant benefits.
What does the course mean by justice in transplantation?
Justice here concerns how scarce goods, such as donated livers and kidneys, should be distributed and whether markets should play a role. The CMA Code commits physicians to improving access and reducing inequities in care. Allhoff asks whether past behaviour can justify lower priority, and Friedman asks whether paying donors would be fairer than a system in which only donors go unrewarded.
Exam move
Draw Allhoff's argument as a tree with a medical branch and a moral branch, and label where the disease concept enters. Write Friedman's argument as three numbered reasons and pair each with the strongest objection. Then invent a short allocation case and practise writing a consultation note that keeps the medical comparison and any judgement of blame in separate sentences.
Finish by explaining aloud how the two authors would agree that group labels should not replace individual assessment.
