Examining the Potential Exploitation of UNOS Policies

Abstract

The United Network for Organ Sharing (UNOS) waiting list was designed as a just and equitable system through which the limited number of organs is allocated to the millions of Americans in need of a transplant. People have trusted the system because of the belief that everyone on the list has an equal opportunity to receive an organ and also that allocation is blind to matters of financial standing, celebrity or political power. Recent events have revealed that certain practices and policies have the potential to be exploited. The policies addressed in this paper enable those on the list with the proper resources to gain an advantage over other less fortunate members, creating a system that benefits not the individual most in medical need, but the one with the best resources. These policies are not only unethical but threaten the balance and success of the entire UNOS system. This paper proposes one possible solution, which seeks to balance the concepts of justice and utility.

Principles for allocation of scarce medical interventions

“…Taking advantage of the fi rst-come, fi rst-served principle, well-off patients place themselves on multiple waiting lists. 57 Exploiting the sickest-fi rst element, some transplant centres have temporarily altered or misrepresented their patients' health state to get them scarce organs, making sickest-fi rst both practically and inherently fl awed. 58,59 Furthermore, UNOS points systems do not appropriately consider the benefi t-maximising principles, prognosis, and saving the most lives, nor do they include youngest-fi rst allocation.…”

Allocation of Places for Patients to Receive Dialysis in Low and Middle Income Countries: An Ethical Framework for Distributive Justice View Edit

“…This system would satisfy utilitarian reasoning while at the same time upholding egalitarian principles and the Rawlsian 'difference principle' of prioritization of the worse off. This balancing of equity and utility is generally accepted by the medical community (11).…”

“…Ethical counter arguments for this system would include that it prioritises young over old and does not include a 'first come first served' and 'sickest first' principles as used in some established allocation systems (7,11). While it may initially seem reasonable to treat people equally regardless of age, this does not take into consideration the fact that the youngest have had the least number of lived years, thus prioritization of the young promotes each persons' right to live through all stages of life and the opportunity for a 'fair innings' of life (7,9).…”

The Human and Economic Dimensions of Altruism: The Case of Organ Transplantation

“…3 The coauthors include one nephrologist, Robert Gaston, two kidney surgeons, Gabriel Danovitch and Arthus Matas; one philosopher, Jeffrey Kahn, and one lawyer, myself. or other benefit (see, for example, Caplan, Zink, and Wertlieb 2004; Zink et al 2005;Steinbrook 2005). But in the midst of these complex attitudes toward altruism, neither the qualified proponents of altruism and nor the skeptics of its efficacy have made little systematic effort to understand its behavioral implications.…”