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


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).


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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