Organ Allocation Dilemmas


More often than not, individuals in a need of a transplant are lucky enough to get an organ in the first place. The central ethical dilemmas that surround organ transportation are induced by the scarcity of available organs. A multitude of people are currently in line awaiting transplants, be it a kidney, liver, lung, or the heart. Therefore, such situation leads to the question of how to fairly and ethically divide the resources since the organs are deficient. According to Bobbert and Ganten (2013), the “sickest first” principle is the most ethical way to allocate the organs. However, despite the scarcity of available organs and the high number of individuals depending on them, the process of organ allocation should be conducted ethically at all times ensuring that it produces more good than evil for everyone. The paper focuses on addressing ethical dilemmas by discussing nursing values as well as the utilitarianism model and, finally, suggests solutions to the ethical problems.


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Nursing Values

As a nurse, one should have moral values and principles to guide them through decision making procedure. It is crucial for one to have respect, equity, autonomy, altruism, transparency, effectiveness, security, care, and well-being (Ladin & Hanto, 2011). These values may be substantial, but they vary according to a given situation too. The case of organ allocation raises diverse ethical dilemmas since there are many proper ways to decide how to give the preference to one individual over the other (Bobbert & Ganten, 2013).

Decision making concerning organ allocation has to incorporate explicit evaluation not only because of the benefits but also of the risks associated with it regarding the potential recipient. The process of allocating organs should in no way be conducted under unreasonable discrimination (Cillo et al., 2015). Besides, there is an obligation to respect choices made by the potential recipients regarding accepting the organ transplantation. Should he or she decide to refuse the transplant due to their belief, religion, or any other personal reasons, the decision has to be respected. What is more, the transplantation can only happen if it is beneficial to the recipient.

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Utilitarianism Model of Ethical Principles

The entire process of organ procurement and allocation is performed for the benefit of the critically ill patients thus the overall welfare of those patients is the primary purpose of the proceeding. The utilitarianism model expounds that an act is moral and justified only if it generates more good than evil for everyone. When applied to the allocation of organs, the model of utility specifies that the process should proceed in a manner of capitalizing the expected excellent standards by entailing the principles of beneficence and non-maleficence (Ahearn, 2016). Notably, the model of utilitarianism requires the comparison of health and harms through measuring the standardized outcomes to determine the allocation that would produce the greatest good. Positive consequences of organ transplant should include saving a life, promoting well-being, relieving impediment and suffering as well as removing psychological impairment. Alternatively, it is significant to compare the desirable results to the possible harmful impacts like mortality, the short-term morbidities, and the long-term morbidities.

The model of utilitarianism scrutinizes both sides of the transplantation comprising effective and helpful techniques as well as the potential threats simultaneously considering not only the medical benefits and trauma. For instance, the principle of utilitarianism when applied to organ allocation contemplates factors such as the patient’s age, quality of life, patient survival, availability of other alternative treatments, and graft survival. Nevertheless, certain social aspects should not matter during organ allocation as one’s social worth or value is not of an essence. It would seem discriminatory to base one’s decision regarding organ allocation on the variations of the transplant outcomes that occur among different social groups to predict individual results in particular (Ahearn, 2016). According to the utility model, such factors should never be considered to justify allocation decisions. The utilitarianism model of distribution excludes the consideration of social acceptance because a patient should be assessed individually and not as a group. A socially advantaged person may have worse transplant outcomes than a socially disadvantaged one. Therefore, organ allocation decisions should not rely on one’s dominant social values or fortune, but they must rather be assessed independently in order to reduce the health care disparities often caused by social inequities.

Resolution of the Ethical Problems

As a result, to solve the ethical issue of organ allocation, it is crucial to maximize the net benefits based on the utilitarianism model. Nonetheless, since there are an only limited numbers of the rare and valuable organs, it is pivotal to use them in a more advantageous manner (Bobbert & Ganten, 2013). It would be better to favor a patient who would indeed live longer over the one with a low life expectancy to avoid wastage of the scarce and valuable commodity, but this move leaves to the question of the moral obligation to give all the patients equal treatment. Conversely, Krutli, Rosemann, Törnblom, and Smieszek (2016) argue that the allocation principles should be balanced against each other since some of them are morally unjustifiable. For example, the waiting list mostly favours the corrupt well-off people while the “sickest first” prefers the sickest person at that moment and ignores those that might be worse in the future. Hence, to resolve the problem of organ allocation, it is imperative to balance all the allocation principles and create the best possible ethical manner of organ allocation.

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In spite of the various ethical considerations mentioned, the distribution of human organs is an issue in the health care that needs much analysis. In this case, the utilitarianism model seems to be the best approach since the organs are valuable and scarce, but it is still better to consider all the possible allocation principles when determining the most suitable recipient of a body part. Moreover, despite the scarcity of the human organs and the high number of people awaiting transplant, it is still vital for the process of organ allocation to be conducted ethically on a regular basis.

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