Spare Parts

On November 19, 1999, The Washington Post began a news story on organ transplant policy this way: "The Republican congressional leadership moved yesterday to derail a hard-won compromise with the Clinton administration aimed at developing a fairer system for organ transplants, outraging the White House and raising concerns that the plan could be delayed indefinitely."

You wouldn't guess it from the story, but this debate involves some serious issues of exquisite moral difficulty. What does "fair" mean in this context? Should the sickest recipients receive preference (as the administration wants), or should some other factor govern–perhaps "youngest first" or "otherwise healthiest" (to make sure that a scarce liver, say, goes to a child rather than a cirrhotic senator)? Are we better served by a few large transplant centers or by a network of smaller local ones? Will more people donate organs if transplant centers are local?

Perhaps the most interesting question does not even enter into the thinking of Congress, the administration, the Department of Health and Human Services, the medical profession, or the general press: Should individual donors or their families be allowed to establish the criteria for how their organs are disposed? (See "Organ Grinders," November 1998.) While living people are allowed to donate organs, such as kidneys, to specific individuals, this is not part of the system for allocating organs from cadavers. But if a question has no clear moral answer, perhaps people should be allowed to answer it for themselves rather than relying on the votes of the political class.