Priority to Organ Donors: Personal Responsibility, Equal Access and the Priority Rule in Organ Procurement

Andreas Albertsen

About author

Dr. Andreas Albertsen
Department of Political Science, Aarhus University
Bartholins Allé 7
building 1332, 117
8000 Aarhus C
Denmark

E-mail: aba@ps.au.dk

This article has benefitted hugely from comments received on a number of occasions. It was presented at the ‘Should personal responsibility play a role in fair healthcare’ at Oslo University, October 2016; at the Annual Meeting in the Danish Political Science Association in Vejle, October 2016; at the ‘Equality, Freedom and the Good Life’ workshop in Aarhus December 2016. I am very grateful for insightful comments provided by David V. Axelsen, Greg Bognar, Jens Damgaard Thaysen, Kristine Bærøe, Siba Harb, Robert Huseby, Holly Lawford-Smith, Kasper Lippert-Rasmussen, Tim Meijers, Søren Flinch Midtgaard, Lasse Nielsen, Liam Shields, Danielle Zwarthoed and Andrew Walton. Work on this article was supported by The Carlsberg Foundation (Grant number: CF14-0896).

Abstract


In the effort to address the persistent organ shortage it is sometimes suggested that we should incentivize people to sign up as organ donors. One way of doing so is to give priority in the allocation of organs to those who are themselves registered as donors. Israel introduced such a scheme recently and the preliminary reports indicate increased donation rates. How should we evaluate such initiatives from an ethical perspective? Luck egalitarianism, a responsibility-sensitive approach to distributive justice, provides one possible justification: Those who decide against being organ donors limit the health care resources available to others. As such, a priority rule can be justified by a luck egalitarian approach to distributive justice. Furthermore, a priority rule inspired by luck egalitarianism is well equipped to avoid prominent criticisms of such a procurement system. Luck egalitarianism provides us with reaons to exempt people who are not responsible for their inability to donate from receiving lower priority, provide sufficient information about donation, and mitigate social and natural circumstances affecting people’s choice to donate.

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References


  1. K. Aita, “New Organ Transplant Policies in Japan, Including the Family-Oriented Priority Donation Clause,” Transplantation (91/5) 2011, p. 489–891.
  2. A. Albertsen, “Luck Egalitarianism, Social Determinants and Public Health Initiatives,” Public Health Ethics (8/1) 2015, p. 42–49.
  3. A. Albertsen, “Tough Luck and Tough Choices: Applying Luck Egalitarianism to Oral Health,” Journal of Medicine and Philosophy (40/3) 2015), p. 342–362.
  4. A. Albertsen, “Drinking in the Last Chance Saloon: Luck Egalitarianism, Alcohol Consumption, and the Organ Transplant Waiting List,” Medicine, Health Care and Philosophy (19/2) 2016, p. 325–338.
  5. A. Albertsen, “Taxing Unhealthy Choices: The Complex Idea of Liberal Egalitarianism in Health,” Health Policy (120/5) 2016, p. 561–566.
  6. A. Albertsen, C. Knight. “A Framework for Luck Egalitarianism in Health and Healthcare,” Journal of Medical Ethics (41/2) 2015, p. 165–169.
  7. F. Allhoff, “Discriminating Against ‘Organ Takers’,” The American Journal of Bioethics (4/4) 2004, p. 31–33.
  8. M. Marchman Andersen, S.O. Dalton, J. Lynch, C. Johansen, and N. Holtug, “Social Inequality in Health, Responsibility and Egalitarian Justice,” Journal of Public Health (35/1) 2013, p. 4–8.
  9. E.S. Anderson, “What Is the Point of Equality?” Ethics (109/2) 1999, p. 287–337.
  10. R.J. Arneson, “Equality and Equal Opportunity for Welfare,” Philosophical Studies (56/1) 1989, p. 77–93.
  11. T. Ashkenazi, J. Lavee, E. Mor, “Organ Donation in Israel—Achievements and Challenges,” Transplantation (99/2) 2015, p. 265–266.
  12. K. Bærøe, C. Cappelen, “Phase-Dependent Justification: The Role of Personal Responsibility in Fair Healthcare,” Journal of Medical Ethics (41/10) 2015, p. 836–840.
  13. N. Biller-Andorno, “Between Solidarity and Self-Interest: How Fair Is the ‘Club Model’ for Organ Donation?” The American Journal of Bioethics (4/4) 2004, p. 19–20.
  14. K.A. Bramstedt, “Is It Ethical to Prioritize Patients for Organ Allocation according to Their Values about Organ Donation?” Progress in Transplantation (16/2) 2006, p. 170–174.
  15. R.C.H. Brown, “Moral Responsibility for (Un)healthy Behaviour,” Journal of Medical Ethics 2013.
  16. A. Buyx, B. Prainsack, “Lifestyle-Related Diseases and Individual Responsibility through the Prism of Solidarity,” Clinical Ethics (7/2) 2012, p. 79–85.
  17. S.P. Calandrillo, L.R. Cohen, D.J. Undis, “LifeSharers: An ‘Opting In’ Paradigm Already in Operation,” The American Journal of Bioethics (4/4) 2004, p. 17–18.
  18. A.W. Cappelen, O.F. Norheim, “Responsibility in Health Care: A Liberal Egalitarian Approach,” Journal of Medical Ethics (31) 2005, p. 476–480.
  19. A.W. Cappelen, O.F. Norheim, “Responsibility, Fairness and Rationing in Health Care,” Health Policy (76/3) 2006, p. 312–319.
  20. J. Chandler, J. Burkell, S. Shemie, “Priority in Organ Allocation to Previously Registered Donors: Public Perceptions of the Fairness and Effectiveness of Priority Systems,” Progress in Transplantation (22/4) 2012, p. 413–422.
  21. G.A. Cohen, Expensive Tastes Ride Again, [in:] Dworkin and His Critics : With Replies by Dworkin, Justine Burley (ed.), Blackwell, Oxford 2004, p. 3–29.
  22. G.A. Cohen, “On the Currency of Egalitarian Justice,” Ethics (99/4) 1989, p. 906–944.
  23. A.J. Cronin, “Points Mean Prizes: Priority Points, Preferential Status and Directed Organ Donation in Israel,” Israel Journal of Health Policy Research (3/1) 2014, p. 8.
  24. N. Daniels, Individual and Social Responsibility for Health, [in:] Responsibility and Distributive Justice, Carl Knight and Zofia Stemplowska (eds), Oxford University Press, Oxford, NY 2011, p. 266–286.
  25. F. Dietrich, “Causal Responsibility and Rationing in Medicine,” Ethical Theory and Moral Practice (5/1) 2002, p. 113–131.
  26. J. Domínguez, J.L. Rojas. “Presumed Consent Legislation Failed to Improve Organ Donation in Chile,” Transplantation Proceedings (45/4) 2013, p. 1316–1317.
  27. D.M. Dudzinski, “Shifting to Other Justice Issues: Examining Listing Practices,” The American Journal of Bioethics (4/4) 2004, p. 35–37.
  28. R. Dworkin, “What Is Equality? Part 2: Equality of Resources,” Philosophy & Public Affairs (10/4) 1981, p. 283–345.
  29. E. Feiring, “Lifestyle, Responsibility and Justice,” Journal of Medical Ethics (34/1) 2008, p. 33–36.
  30. J. Fishkin, Bottlenecks: A New Theory of Equal Opportunity, Oxford University Press, New York, NY 2014.
  31. L.M. Fleck, “Whoopie Pies, Supersized Fries,” Cambridge Quarterly of Healthcare Ethics (21/1) 2011, 6318 p. 5–19.
  32. M.D. Fox, M.R. Allee, G.J. Taylor, “Opting for Equity,” The American Journal of Bioethics (4/4) 2004, p. 15–16.
  33. S. Goering, A. Dula, “Reasonable People, Double Jeopardy, and Justice,” The American Journal of Bioethics (4/4) 2004, p. 37–39.
  34. B.F. Gruenbaum, A. Jotkowitz, “The Practical, Moral, and Ethical Considerations of the New Israeli Law for the Allocation of Donor Organs,” Transplantation Proceedings (42/10) 2010, p. 4475–4478.
  35. C. Hackler, “Conscientious Objection to an Opt-in System,” The American Journal of Bioethics (4/4) 2004), p. 25–26.
  36. H.L.A. Hart, The Principle of Fairness, [in:] Political Thought, Michael Rosen and Jonathan Wolff (eds), Oxford University Press, Oxford 1999, p. 71–72.
  37. G. den Hartogh, “Priority to Registered Donors on the Waiting List for Postmortal Organs? A Critical Look at the Objections,” Journal of Medical Ethics 2010.
  38. T.K.K. Iyer, “Kidneys for Transplant — ‘Opting Out’ Law in Singapore,” Forensic Science International (35/2–3) 1987, p. 131–40.
  39. L. Jacoby, “Solidarity: An Important Aspect of the ‘Opting In’ Paradigm,” The American Journal of Bioethics (4/4) 2004, p. 16–17.
  40. A. Jotkowitz, “New Models for Increasing Donor Awareness: The Role of Religion,” The American Journal of Bioethics (4/4) 2004, p. 41–42.
  41. J.B. Kessler, A.E. Roth, “Organ Allocation Policy and the Decision to Donate,” American Economic Review (102/5) 2012, p. 2018–2047.
  42. J.B Kessler, A.E. Roth, “Loopholes Undermine Donation: An Experiment Motivated by an Organ Donation Priority Loophole in Israel,” Journal of Public Economics (114) 2014, p. 19–28.
  43. C. Knight, “The Metaphysical Case for Luck Egalitarianism,” Social Theory and Practice (32/2) 2006, p. 173–189.
  44. C. Knight, Luck Egalitarianism, Edinburgh University Press, Edinburgh 2009.
  45. C. Knight, “Luck Egalitarianism,” Philosophy Compass (8/10) 2013, p. 924–34.
  46. T. Koch, Scarce Goods: Justice, Fairness, and Organ Transplantation, Praeger, Westport, Conn 2002.
  47. A.J. Kolber, “Matter of Priority: Transplanting Organs Preferentially to Registered Donors,” Rutgers L. Rev. (55) 2002, p. 671.
  48. J. Lavee, T. Ashkenazi, G. Gurman, D. Steinberg. “A New Law for Allocation of Donor Organs in Israel,” The Lancet (375/9720) 2010, p. 1131–1133.
  49. J. Lavee, T. Ashkenazi, A. Stoler, J. Cohen, R. Beyar, “Preliminary Marked Increase in the National Organ Donation Rate in Israel Following Implementation of a New Organ Transplantation Law: Increase in National Organ Donation Following New Law,” American Journal of Transplantation (13/3) 2013, p. 780–785.
  50. J. Lavee, D. W. Brock, “Prioritizing Registered Donors in Organ Allocation: An Ethical Appraisal of the Israeli Organ Transplant Law,” Current Opinion in Critical Care (18/6) 2012), p. 707–711.
  51. J. Le Grand, Individual Responsibility, Health, and Health Care, [in:] Inequalities in Health: Concepts, Measures, and Ethics, Nir Eyal, Samia Hurst, Ole Frithjof Norheim, and Daniel Wikler (eds), Population-Level Bioethics Series, Oxford University Press, Oxford 2013, p. 299–306.
  52. D. Li, Z. Hawley, K. Schnier, “Increasing Organ Donation via Changes in the Default Choice or Allocation Rule,” Journal of Health Economics (32/6) 2013), p. 1117–1129.
  53. K. Lippert-Rasmussen, “Arneson on Equality of Opportunity for Welfare,” Journal of Political Philosophy (7/4) 1999, p. 478–487.
  54. K. Lippert-Rasmussen, Luck Egalitarianism, Bloomsbury Ethics, Bloomsbury, 2015.
  55. J.M. List, “‘Opting-In’ and Unnecessary Penalties for Non Kidney Donors,” The American Journal of Bioethics (4/4) 2004, p. 39–41.
  56. T.F. Murphy, R.M. Veatch, “Members First: The Ethics of Donating Organs and Tissues to Groups,” Cambridge Quarterly of Healthcare Ethics (15/1) 2006, p. 50–59.
  57. M.S. Nadel, “Refining an ‘Opt In’ Approach,” The American Journal of Bioethics (4/4) 2004, p. 51–52.
  58. M.S. Nadel, C.A. Nadel, “Using Reciprocity to Motivate Organ Donations,” Yale Journal of Health Policy, Law, and Ethics (5) 2005, p. 293–325.
  59. J.L. Nelson, “Utility, Fairness, and What Really Matters in Organ Provision,” The American Journal of Bioethics (4/4) 2004, p. 27–29.
  60. L. Nielsen, “Taking Health Needs Seriously: Against a Luck Egalitarian Approach to Justice in Health,” Medicine, Health Care and Philosophy (16/3) 2013, p. 407–416.
  61. L. Nielsen, D.V. Axelsen, “Three Strikes Out: Objections to Shlomi Segall’s Luck Egalitarian Justice in Health,” Ethical Perspectives (19/II) 2012, p. 307–316.
  62. E. Rakowski, Equal Justice. Oxford: Clarendon, 1993.
  63. V. Ravitsky, “Incentives for Postmortem Organ Donation: Ethical and Cultural Considerations,” Journal of Medical Ethics (39/6) 2013, p. 380–381.
  64. J.E. Roemer, Equality of Opportunity, Harvard University Press, Cambridge [u.a.] 1998.
  65. B. Saunders, “Altruism or Solidarity? The Motives for Organ Donation and Two Proposals,” Bioethics (26/7) 2012, p. 376–381.
  66. H. Schmidt, “Just Health Responsibility,” Journal of Medical Ethics (35/1) 2009, p. 21–26.
  67. V.H. Schmidt, C.H. Lim, “Organ Transplantation in Singapore: History, Problems, and Policies,” Social Science & Medicine (59/10) 2004, p. 2173–2182.
  68. S. Segall, “In Solidarity with the Imprudent: A Defense of Luck Egalitarianism,” Social Theory and Practice (33/2) 2007, p. 177–198.
  69. S. Segall, Health, Luck, and Justice, Princeton, Princeton, NJ 2010.
  70. S. Segall, Luck Prioritarian Justice in Health, [in:] Responsibility and Distributive Justice, Carl Knight and Zofia Stemplowska (eds), Oxford University Press, Oxford, NY 2011, p. 246–265.
  71. S. Segall, “Health, Luck, and Justice Revisited,” Ethical Perspectives (19/II) 2012, p. 326–334.
  72. S. Segall, Equality and Opportunity, Oxford University Press, 2013.
  73. S. Segall, Equality of Opportunity for Health, [in:] Inequalities in Health: Concepts, Measures, and Ethics, Nir Eyal, Samia Hurst, Ole Frithjof Norheim, and Daniel Wikler (eds), Population-Level Bioethics Series, Oxford University Press, Oxford 2013, p. 147–163.
  74. L. Shepherd, R.E. O’Carroll, E. Ferguson, “An International Comparison of Deceased and Living Organ Donation/transplant Rates in Opt-in and Opt-out Systems: A Panel Study,” BMC Medicine (12/1) 2014.
  75. G. Siegal, “Making the Case for Directed Organ Donation to Registered Donors in Israel,” Israel Journal of Health Policy Research (3/1) 2014, p. 1.
  76. A.J. Simmons, “The Principle of Fair Playm” Philosophy & Public Affairs (8/4) 1979, p. 307–337.
  77. D. Sperling, G.M. Gurman, “Factors Encouraging and Inhibiting Organ Donation in Israel: The Public View and the Contribution of Legislation and Public Policy,” Journal of Bioethical Inquiry (9/4) 2012, p. 479–497.
  78. D. Steinberg, “A Response to Commentators on ‘An “Opting In” Paradigm For Kidney Transplantation’,” The American Journal of Bioethics (4/4) 2004, p. 35–37.
  79. D. Steinberg, “An ‘Opting In’ Paradigm for Kidney Transplantation,” The American Journal of Bioethics (4/4) 2004, p. 4–14..
  80. A. Stoler, J.B. Kessler, T. Ashkenazi, A.E. Roth, J. Lavee, “Incentivizing Authorization for Deceased Organ Donation With Organ Allocation Priority: The First 5 Years,” American Journal of Transplantation (16/9) 2016, s. 2639–2645.
  81. A. Stoler, J.B. Kessler, T. Ashkenazi, A.E. Roth, J. Lavee, “Incentivizing Organ Donor Registrations with Organ Allocation Priority: Incentivizing Organ Donor Registrations with Organ Allocation Priority,” Health Economics 2016.
  82. B. Teo, “Organs for Transplantation The Singapore Experience,” The Hastings Center Report (21/6) 1991, p. 10.
  83. G. Trotter, “Preferred Allocation for Registered Organ Donors,” Transplantation Reviews (Orlando, Fla.) (22/3) 2008, p. 158–162.
  84. D.J. Undis, “Changing Organ Allocation Will Increase Organ Supply,” DePaul L. Rev. (55) 2005, p. 889.
  85. A. Vathsala, “Improving Cadaveric Organ Donation Rates in Kidney and Liver Transplantation in Asia,” Transplantation Proceedings (36/7) 2004, p. 1873–1875.
  86. R.M. Veatch, Transplantation Ethics, Georgetown University Press, Washington, D.C. 2000.
  87. K. Voigt, “Appeals to Individual Responsibility for Health,” Cambridge Quarterly of Healthcare Ethics (22/2) 2013, p. 146–158.
  88. D. Wikler, Personal and Social Responsibility for Health, [in:] Public Health, Ethics, and Equity, Sudhir Anand, Fabienne Peter, and Amartya Sen (eds), Oxford University Press, Oxford, NY 2004, p. 109–135
  89. M. Wilkinson, S. Wilkinson, “The Donation of Human Organs,” [in:] Edward N. Zalta (ed.), The Stanford Encyclopedia of Philosophy (Winter 2016 Edition), 2011, URL = https://plato.stanford.edu/archives/win2016/entries/organ-donation.
  90. A. Zúñiga-Fajuri, “Increasing Organ Donation by Presumed Consent and Allocation Priority: Chile,” Bulletin of the World Health Organization (93) 2015, p. 199–202.

DOI:

http://dx.doi.org/10.13153/diam.51.2017.1035

Article links:

Default URL: http://www.diametros.iphils.uj.edu.pl/index.php/diametros/article/view/1035
English abstract URL: http://www.diametros.iphils.uj.edu.pl/index.php/diametros/article/view/1035/en

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