PHIL103: Moral and Political Philosophy

Decision-making becomes necessary at two stages of the process of organ and tissue allocation. The first stage deals with those considerations which should be taken into account in deciding on the identity of the individual patients to whom offers of transplants are to be made. Decisions of this type, by reason of the technical details involved, will remain a responsibility of medical personnel. Entry to, and exclusion from, a transplantation program both raise ethical issues.

Entry to a program is offered following assessment of patients by the program personnel. Exclusion criteria include age restrictions, abnormalities in other organ systems, previous history of malignant disease and other medical considerations. In making decisions about which patients are to be admitted to a program, there is merit in more than one medical practitioner being involved.

The second stage of decision-making relates to whether an individual chooses to become a transplant recipient. This is a decision to be made by the patients in the light of advice received from their medical attendants and consultation with their families. Acceptance of the offer requires an informed decision on the part of a patient and/or their family. Prior to this decision, a patient should receive a full description of what is entailed in being in the program, what procedures can be expected and their possible risks and benefits. On the other hand, if a patient is excluded from a transplantation program, he or she is entitled to know why?.

In an attempt to ensure that transplanted kidneys have the best outcome possible for individual patients, concurrent medical conditions that introduce a potential risk following transplantation should be managed before acceptance on to the waiting list, If a pre-existing condition is likely to be affected adversely by the ongoing immunosuppression required after transplantation (for example, immunosuppression increases the risk of recurrence of cancer and of persistence of chronic infection) a patient may be excluded from transplantation in his or her own interest. Though some may think it is unfair to deny a patient the opportunity to receive a transplanted kidney because of renal disease which could recur in the graft, others might consider it unreasonable to inflict repeated transplantation when there is a high risk of rejection. In rare circumstances, the kidney allocation system may be suspended to provide an organ for transplantation to a critically ill patient. To ensure fairness in allocation, the selection criteria and weighting of different criteria are subject to repeated review by personnel from all institutions involved in renal transplantation.