On giving preference to prior volunteers when allocating organs for transplantation.

In this issue of the journal Rupert Jarvis argues for a simple idea-a 'modest proposal'-that he believes will radically increase the supply of organs for trans-plantation (1). Given the existing shortage of donor organs for transplantation it would be entirely just, he reasons, for our society to give priority for receipt of organs for transplantation to those patients who had previously volunteered to donate their own organs. Once such a scheme was promulgated, the incentive to volunteer as an organ donor would, he plausibly argues, become very great indeed, and thus the supply of organs would become much larger than at present. Many positive benefits of such a scheme are claimed by Mr Jarvis. It meets, he argues the Aristotelian criterion for distributive justice in that people are treated unequally only if there are morally relevant differences between them; including the morally relevant difference of whether or not they themselves had been prepared to contribute to the scheme from which they wish to benefit. The scheme, he says, tends to promote altruism-'albeit self-regarding' altruism. Moreover, aligning the individual's self-interest with the public good tends to promote both the satisfaction of individual self-interest and the public good, both of which are morally desirable. The scheme respects the autonomy of donors with minimal coercion. And if sufficient organs are donated as a result of the scheme's success, it could also make possible organ transplants for those who had not previously volunteered their own organs. If one pursues the moral analysis using the Beauchamp and Childress 'four principles', along with consideration of their scope of application, Mr Jarvis's 'modest proposal' certainly does seem to meet some standard moral requirements. As he points out, respect for donors' autonomy is achieved in that donors are not coerced into volunteering their own organs. His proposal does not even involve the element of coercion by inertia that a presumed consent law would allegedly entail. People are simply positively rewarded for volunteering their organs and thus behaving in a way that is both of potential benefit to themselves and also of potential benefit to others. So far as the autonomy of potential recipients is concerned, all would retain their right to have their autonomy respected if they refused treatment. As for their preference to be given treatment by organ transplant should they need it, suffice it here merely to assert that this is not strictly an issue of …