The Ethics of Organ Transplantation
Imagine being told that you need a new liver, but that you would have to wait behind thousands of other people on the UNOS list. This was the case for Todd Krampitz of Houston. Krampitz, a newlywed, was informed that he had a large tumor in his liver and that it would need to be replaced. As he was in no immediate danger of dying, Krampitz was not moved to the top of the list. Therefore, he had a long wait ahead of him. Krampitz was able to jump ahead in line by advertising his cause throughout Houston though the use of billboards and television ads. A family (which remains anonymous to the public at large) donated a liver to Todd, putting him ahead of the thousands of other recipients on the UNOS list. The criticism surrounding this method involved the fact that others may not have the money to afford to put up billboards, and therefore Krampitz’s actions were unfair. A dissenting point of view was that the family in question might not have donated at all had it not been to the attention Krampitz brought to the subject of organ donation.
There are 93,826 people on the waiting list for an organ as of November 3, 2006. 17,115 of those people are waiting for a liver, and in 2004, 6,642 people received a liver under the UNOS program. The patients are assessed to receive an organ based on many factors, the most important being how close they are to dying without the transplant. Most potential recipients accept the fact that they will need to spend months, even years on the list before receiving a suitable organ. They wait their turn and hope for the best. The concept of distributive justice asks the question: is it more important to give the organ to an individual who is dying, or an individual who is in no immediate danger of dying but who has the best chance of life? The way UNOS is currently run allows for those who are closest to death to receive available organs first. Unfortunately, another aspect of distributive justice allows for priority of scarce resources to go to those with “restricted opportunities”, but there is little agreement on how much priority to give in these cases (Daniels, 1996, p.1).
The main problem with organ transplantation is the scarcity of these organs. Adults can indicate that they would like to donate organs after death by making a notation on their driver’s licenses. However, hospital employees tend to ask the family before completing the transplant. This procedure reduces the number of available organs because 1) the family is often unaware of the deceased’s wishes; 2) the family is under a great deal of stress and do not wish to make such a decision at this time. Consequently, more than 50 percent of families refuse to give consent (Caplan, 1998, p.148). In fact, one study concluded that, “the major impediment to procurement was the low rate of family consent.”
Krampitz may have had that statistic in mind when he decided to go public with his need for a new liver. The first argument is that he was completely unethical in skipping ahead in the UNOS line because he had a financial advantage over those who cannot afford to advertise their dilemmas. The truth is that individuals with good insurance and who are wealthier are more likely to be placed on the UNOS list in the first place. According to Caplan in The Ethics of Organ Transplants, “A patient who is able to pay is more likely to get a transplant than one who is not.” This is true for most costly medical procedures – no money, no treatment. With that statistic in mind, it is difficult to find fault with Krampitz’s method of securing a liver – the practice of medical care in exchange for payment, regardless of the circumstances of the patient, was established long before Krampitz was even born.
The second argument in supporting Krampitz is that no one can possibly know if the family would have donated a liver to anyone if it hadn’t been for his publicity. Considering that more than 50 percent of families refuse to donate organs, it is entirely possible that the donor family was swayed by Kramptiz’s personalization of the organ scarcity plight. The article on Krampitz’s cutting in line mentioned that Congress should act quickly to close the loophole that allowed Krampitz to secure a liver in this way, but such an act would violate an individual’s right to privacy in medical matters. A family should be able to designate a recipient for an organ if they wish. This loophole might prevent families from donating organs to other family members or their friends. One simply must accept that there are many practices that will never be entirely fair, but leveling out the playing field will limit personal freedoms.
Krampitz died on April 26th, 2005, though the cause of death was not made public. While it could have been a resurgence of his tumor, it could also have been organ failure or any number of other reasons. Krampitz donated his corneas for transplantation, thus giving the gift of sight to a needy individual. In addition, his family started the Todd Krampitz Foundation, an organization whose goal is to promote awareness of organ transplantation. One can safely say that Krampitz did not take his own gift for granted.
Caplan, A. L. & Coelho, D. H. (Eds.). (1998). The Current Debate The Current Debate. Amherst, NY: Prometheus Books.
Daniels, N., Emanuel, E. J., & Jennings, B. (1996). Is Justice Enough? Ends and Means in Bioethics. The Hastings Center Report, 26(6), 8+.
(2006 Oct 27). Liver Median Waiting Times. Retrieved November 3, 2006, from OPTN: Organ Procurement and Transplantation Network Web site: http://www.optn.org/latestData/rptStrat.asp
(2006 Apr 26). Man who used billboards to get liver dies. Retrieved November 3, 2006, from MSNBC.com Web site: http://www.msnbc.msn.com/id/7640146/