Priority systems in the allocation of organs for transplant: should we reward those who have previously agreed to donate?

Organ transplantation has been described “with only slight exaggeration [as] usher[ing] in the age of bioethics” as it has focused public attention on the practice and its associated ethical issues. These compelling ethical issues have inspired a voluminous body of writing in the medical, legal and philosophical literature. These authors debate the intrinsic morality of transplantation. Long-standing prohibitions against the mutilation of the body compete with the suggested moral duty to assist those in need. Although it is now commonly accepted, the ethics of voluntary living donation are sometimes questioned given its lack of benefit to the donor and the medical ethical requirement of non-maleficence. Another issue arises from the definition of death. The old definition relied on the cessation of cardio-respiratory function but was not satisfactory from the perspective of organ donation as oxygen deprivation damages the organs. The move to a brain-death definition permitted organs to be preserved through life support.