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Organ Transplantation in the Face of Donor Shortage : Ethical Implications with a Focus on Liver Allocation

Title data

Lauerer, Michael ; Kaiser, Katharina ; Nagel, Eckhard:
Organ Transplantation in the Face of Donor Shortage : Ethical Implications with a Focus on Liver Allocation.
In: Visceral Medicine. Vol. 32 (2016) Issue 4 . - pp. 278-285.
ISSN 2297-4725
DOI: https://doi.org/10.1159/000446382

Abstract in another language


Transplantation medicine is associated with several ethical issues related to the lack of organs. Major questions concern the regulations for giving permission for organ removal, informing the public about organ donation, setting of organ allocation priorities, waiting list access, and strategies to counteract scarcity.

This contribution is based on analyses of legal regulations, guidelines of self-regulatory bodies, administrative data, and literature from medical, normative, and empiric disciplines. It addresses the above-mentioned issues descriptively with a focus on Germany and liver transplantation.

The basic principle of beneficence justifies a shift from voluntariness towards an obligation to document one's decision regarding organ donation. Organ allocation is obviously tangent to fundamental values and concepts of justice. At that, there is no consistent agreement on whether to prioritize the sickest patient or to maximize the overall health benefit. Restrictions relating to waiting list access are the subject of controversies. The reasons for denial of access are largely related to high demands on the prospect of success. Strategies to counteract organ scarcity partly conflict with the respect for autonomy, non-maleficence, beneficence, or justice.

We propose to focus on recent most promising strategies to counteract scarcity in the short-term: demanding a documented decision on organ donation and an orientation towards the Spanish model of organization. Concepts for waiting list access should constantly be reviewed considering all medical evidence and must not be based on moralism. Moreover, we suggest to consider public preferences for organ allocation and strengthen the confidence in transplantation medicine.

Further data

Item Type: Article in a journal
Refereed: Yes
Institutions of the University: Faculties > Faculty of Law, Business and Economics > Chair Healthcare Management and Health Sciences > Chair Healthcare Management and Health Sciences - Univ.-Prof. Dr. Dr. Dr. h.c. Eckhard Nagel
Result of work at the UBT: Yes
DDC Subjects: 600 Technology, medicine, applied sciences > 610 Medicine and health
Date Deposited: 11 May 2020 08:16
Last Modified: 11 May 2020 08:16
URI: https://eref.uni-bayreuth.de/id/eprint/54370