Human Exceptionalism

Age Discrimination in Organ Transplantation?

It looks as if we are beginning to enter an era of age discrimination in health care. As is usually the case in matters such as this, the perniciousness enters on the back of what may be deemed a reasonable thesis: In this case, people who will enjoy transplanted organs longer should have first priority, that is, younger transplant recipients should take priority over older.

This is a difficult matter, to be sure. When a ship is sinking, we used to say women and children first, since it perceived to be the moral duty of men to protect those perceived as weaker. (Today, we would still say protect the children first.) But is this example the same thing as discriminating in favor of the young when it comes to receiving an organ?

The organ shortage puts pressure on the system, sometimes leading to unethical proposed remedies–such as harvesting people diagnosed with persistent vegetative state. Basing one’s place in the waiting list on age also seems ethically unsound. The decision should be based on the patient’s health, expected efficacy of the organ, and time waiting on the list, it seems to me, not age. (For example, it was wrong to give Mickey Mantle a new liver because he had metestatic cancer.) But it is a matter that needs to be discussed.

The arguments from both sides are well presented in this Chicago Tribune story (printed in the Kansas City Star): “Data released at the Dallas meeting suggest transplant patients in the U.S. would live an extra 11,457 years under the new allocation scheme because more people would receive kidneys that would last longer. ‘I think there are advantages to this approach. . . . Now that (this number) is on the table, it’s hard for me to go back and say we shouldn’t try to achieve this,’ said Dr. Mark Stegall, chief of transplantation surgery at the Mayo Clinic.

“Stegall headed the study group that prepared the proposal for the Organ Procurement and Transplantation Network, which has government authority to oversee transplants.

He emphasized that the proposal hadn’t been finalized. Preliminary plans call for several more meetings this year and a public comment period after a formal proposal is issued.

‘Many of us feel there have not been enough discussion along the way in the development of this proposal and would like to see a much more robust public debate,’ said Dr. J. Richard Thistlethwaite, a transplant surgeon and professor at the University of Chicago. ‘People don’t understand the implications of what’s being suggested.’

“Thistlethwaite said he is uncomfortable with the value judgments he believes are inherent in the proposed system, particularly the emphasis on duration of life over quality of life. ‘How can we judge who’s more deserving and whose life we value the most?’ he asked. ‘Where do we draw the line?'”

So, is including age in setting one’s place on the waiting list merely triage or unethical diminution of the worth of the lives of older people? Discuss.

HT: Vicki McKenna

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