INVESTIGADORES
DE ORTUZAR Maria Graciela
capítulos de libros
Título:
Interdisciplinary ethical committes for determining criteria of organ allocation in Argentina
Autor/es:
DE ORTÚZAR MARÍA GRACIELA
Libro:
Bioethics: Latin American Perspectives
Editorial:
Rodopi. ( Edits. Arleen Salles, MJ Bertomeu- Por invitación)
Referencias:
Lugar: Amsterdam/ NY; Año: 2002; p. 171 - 192
Resumen:
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
philosophers commitment to ethical issues within the community.