Interdisciplinary ethical committes for determining criteria of organ allocation in Argentina

DE ORTÚZAR MARÍA GRACIELA

Bioethics: Latin American Perspectives

Rodopi. ( Edits. Arleen Salles, MJ Bertomeu- Por invitación)

Lugar: Amsterdam/ NY; Año: 2002; p. 171 - 192

Any criterion used to determine how to allocate indivisible and scarce resources such as organs entails that some patients will not receive the needed good. In the case discussed in this chapter, the ethical problem lies in justifying the criteria for determining who is going to receive a needed organ. More specifically, the ethical discussion revolves around the determination of the morally relevant characteristics for accepting or rejecting patients in the two stages of selection for transplantation. International and national protocols for organ allocation generally use the criterion of medical utility based on compatibility. Underlying this criterion is the belief that transplant success depends solely on a higher compatibility between donor and recipient. However, medical considerations do not support this argument. In the first place, because the development of immunosuppressant drugs allows for good results with low compatibility. In the second place, because the direct correlation between compatibility and transplant efficiency has not been proven in the case of cadaver transplant where donor and recipient have different genetic characteristics. However, we saw that beyond the purely medical facts, this criterion discriminates against some populations, for example, blacks. Following the publication of statistics and registers of such discrimination, large international centers modified their criteria for renal distribution to alter the unfairness caused by the alleged absolute correlation between compatibility and efficiency. Yet, in many countries, including Argentina, criteria of medical and social utility are overtly or covertly operative. In this chapter, I argued that decisions on who is admitted in a waiting list for transplantation should not be solely determined by medical experts, since no medical and genetic argument to set a rule for organ-rationing exists. Furthermore, selection of patients should not be based on values that favor discrimination because of morally arbitrary reasons, masking “social utilitarianism” under the guise of “medical utilitarianism.” Organ distribution should be based on social decisions ruled by impartial criteria. The Rawls-Daniels theory that defends the right to health is a valuable contribution for grounding equal rights to be admitted into the waiting list, and yet the maximin criterion cannot be used exclusively to favor fairness in every single case. The difference principle cannot be strictly applied because it would only favor the worst situated group (medically and socially) in the process of the final allocation of organs. Fairness and efficiency should be balanced in the distribution of a scarce resource. The distribution criteria for scarce organs should be justified through processes of democratic deliberation set by interdisciplinary ethics committees. These should aim at establishing public criteria for patient-selection and final allocation of organs, and those criteria should be reviewed regularly.[i]   [i]. This chapter has been written thanks to the valuable contribution of ideas and criticisms of María Julia Bertomeu who aroused my concern for applied ethics and for the philosopher’s commitment to ethical issues within the community.