More than 100,000 people are on waiting lists for organ transplants in the United States. Figuring out how to fairly distribute the limited supply of available organs, and how to find more access to available organs is an enormous challenge. Policy makers and organ transplant centers have to consider and deal with a multitude of ethical and legal issues. The following is a list of just a few of them.

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ETHICAL ISSUES: ORGAN DISTRIBUTION

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Guidelines​ vary across transplant centers when it comes to deciding who is eligible for a transplant. For instance:

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• Many transplant centers will not accept people without insurance.

• Transplant teams rarely consider anyone over 75 years of age.

• Some centers exclude patients with moderate mental retardation, mental health challenges, HIV, a history of addiction, or a long criminal record.

• Some transplant programs will admit undocumented immigrants, but most of those are children.

• Some transplant centers have caused controversy by refusing to retransplant organs in undocumented immigrants whose initial organs, received at the same hospital during childhood, have failed.

• Some hospitals do not accept persons who use marijuana, including medical marijuana.

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Value judgments and economic considerations affect who is admitted to waiting lists and who gets available organs, calling into question the justice and fairness of distribution practices.

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SOCIAL ISSUES: INCREASING SUPPLY

 

It is essential to increase the supply of donated organs; however, existing state policies have not significantly driven an increase in donations. Over the years, states have tried to provide organ donation cards, required hospitals to ask families about organ donation, and created state-operated online registries.

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Because of the lack of success of these options, new strategies being considered include a policy of presumed consent, where people are presumed to want to donate their organs when they die. Many European countries are already using this method, and have achieved about a 25% higher donation rate than in other countries that don't use presumed consent.

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LEGAL ISSUES: ORGAN MARKETS​

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Two options have been discussed to provide ways for people to sell their organs. One strategy is to change the National Organ Transplant Act (NOTA), the federal law that bans organ sales.  The other strategy is a regulated market in which the government would be able to purchase organs, setting a fixed price and enforcing rules for selling organs.

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Both of these options have been highly debated for ethical concerns. One concern is that poor people would willingly sell their organs out of necessity to provide for their families. Others are concerned that an organ market violates medical ethics to "do no harm."  In an organ transplant market, doctors and nurses would be aiding those who make the choice to do harm to themselves in exchange for financial compensation.