Faculty Bibliography

Those who advocate rationing access to health care to control escalating costs must adequately examine the field of organ transplantation, where rationing has been a harsh fact of life for many years. In our society, two paradigmatic cases illustrate rationing: a lifeboat with too many passengers aboard for the supply of food and water to keep alive, and battlefield triage with more wounded soldiers than medical personnel available to treat them. Examination of these cases reveals four criteria that must be fulfilled for rationing to be the only possible response to a resource shortage: Nothing can be done to stretch or divide the available resource to meet the needs of all seeking access to it. Those who seek access to the scarce resource need it to survive. Nothing can be done to increase the supply of the resource that is available. The resource is recognized as a benefit by both those who seek it and those who can provide it. For the most part, transplant decisions are surrounded by secrecy, and public input is minimal. Although many centers use psychosocial as well as medical criteria in deciding whom to admit to transplant programs, no consistent criteria have been developed among transplant centers. This secrecy and inconsistency could damage public support of organ transplant programs. If rationing is instituted in other areas of health care, public input must be sought in establishing equitable standards. The scarcity of organs for transplant cannot be changed, but this is not true in other areas of health care, where we can choose to build more facilities, eliminate waste, and dispense with unnecessary services.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ronnie DeSillers] first received national attention - even the attention of the president of the United States - when money raised for a life-saving liver transplant was stolen from his school. The resulting publicity helped raise $400,000, but the cost of three transplants, more than $600,000, exhausted even these funds. Throughout Ronnie's ordeal, the media, the politicians and the public took a keen interest in his story. How could anyone not do so?

KIE: The shortage of organs and tissues for transplantation in infants is particularly severe. Caplan considers the moral and public policy implications of utilizing abortuses and brain dead or anencephalic infants as donors. Arguments favoring their use include the potential benefits for research, benefits to existing infants born with fatal conditions, the ethical cost of relying on primates as sources of organs, and the providing of solace to grieving parents. Arguments against their use include the potential for coercion or conflict of interest in parental decisions about donation, the possibility that abortion may be encouraged, the fact that brain death is difficult to diagnose in infants while organ procurement from anencephalics may be considered murder, and the charge that an increase in infant transplants would be too costly. Caplan concludes that the arguments for using abortuses, anencephalics, and brain dead infants as organ and tissue donors outweigh the arguments against.

The Vatican says anyone who provides or seeks such testing with the intent of inducing an abortion depending on the results is committing a "gravely illicit act." It further condemns civil or health authorities who in any way favor a link between prenatal diagnosis and the option of abortion

Viewed in another way, however, the statement is not so much new as it is a reaffirmation of the Roman Catholic Church's longstanding teaching against sexual conduct outside the realm of marriage and procedures, including contraception, that separate sex from procreation. Add to these views the Vatican's recent statements on the moral illicitness of homosexuality, and there should have been no doubt in anyone's mind about what would ensue when the Congregation for the Doctrine of the Faith turned its collective mind to evaluating technologically assisted forms of reproduction

Marrow transplants may even be more important. They could prove helpful in reversing the massive radiation injuries that would result from a nuclear holocaust or a Chernobyl-style nuclear plant catastrophe. There is even the possibility that those suffering from the horrors of AIDS may find marrow transplants helpful as such a procedure might allow the victims of this plague to replace their dysfunctional marrow cells with healthy, uninfected tissue

Arthur L. Caplan reviews "A History and Theory of Informed Consent," by Ruth R. Faden and Tom L. Beauchamp