I am no medical professional, I just watch medical dramas on TV and have a sister who is a doctor. As I understand it, one of the guiding principles of medical ethics is that in prioritizing patients, you decide based on whose needs are most urgent. It doesn't matter who the person is, what their job is, or if they're a good or bad person, it should be based on who needs it most. No I'm not gonna ask about whether having to pay for medical care contradicts this (my sister believes so though, and is an adamant supporter of universal healthcare as am I) My question is whether, through the lens of this guiding principle, the way they decide who gets organs is fair. As I understand it (and I may be off because I haven't checked my facts and am going by memory) the list of people awaiting organs is dependent on factors related to whether the organ will stay healthy. A principle based on resource scarcity and not wanting to waste an organ on someone who will misuse it. A person awaiting a liver transplant can be denied it for drinking alcohol. Is this merit based system fair from the standpoint of the guiding principle listed above? Is it considered an acceptable exception because of the resource scarcity?
Medical ethics is a tough business because it's about making hard choices. When a choice must be made regarding who gets the liver it doesn't completely depend on whose needs are most urgent, who has the best chance for survival post transplant is also considered That may be where the alcoholic scores lower than the teetotaler and dies while the teetotaler gets the liver and lives. Shades of Mickey Mantle.
I was in radiology for 27 years and my points of view towards medicine changed dramatically over time. No, as far as who gets an organ it's all how the case manager nurse writes his/her notes. They can sink a transplant patient with a single sentence in their notes. I personally have been affected because I wanted to give a 'living donor' partial liver transplant to a friend who lives a few states away from me. The case manager nurse made a single note, that she felt it would be a 'waste' of a liver since I lived so far away. Didn't matter that I was willing to live in that state for weeks to give the donor liver, pay my hotel expenses and all the other costs involved. So one of my best friends died, even though they had a perfectly matched donor. In the short time I worked in radiation therapy (a year) I spent time with the chief radiologist (MD) and the manager and was quizzed on 'why radiation therapy'. I gave the spiel about wanting to help people and was told that medicine isn't about curing disease, it's about making money. If people get cured along the way, great, if not, make sure the billing is accurate. I was told that many times over my career. To answer your question, no, it's not fair how organs are assigned. Money talks and VIPs go to the head of the list whether hospitals will admit it or not.
