THE SUBTLE POLITICS OF ORGAN DONATION - A PROPOSAL

Organs available for transplantation are scarce and valuable medical r esources and decisions about who is to receive them should not be made more difficult by complicated calculations of desert. Consideration o f likely clinical outcome must always take priority when allocating su ch a precious resource otherwise there is a danger of wasting that res ource. However, desert may be a relevant concern in decision-making wh ere the clinical risk is identical between two or more potential recip ients of organs. Unlikely as this scenario is,such a decision procedur e makes clear the interdependence of organ recipient and organ donor a nd hints at potential disadvantages for those who are willing to accep t but unwilling to donate organs (free-riders). A combined opting-out and preference system weakens many of the objections to opting-out sys tems and may make the decision to donate organs on behalf of their dec eased relatives easier for families.