One of the most topical issues in organ transplantation is whether or not it is ethical to perform such complex operations on elderly patients. Between 1998 and 2013, the number of kidney transplants performed annually on adults over 65 triple tripled, and the number of liver transplant recipients nearly doubled (Span, 2013.) The ethics of the increase in elderly transplant candidates has been debated because transplant candidates are given an “allocation score” that places the people with the highest risk of mortality at the top of the list instead of those people who have waited longest. In 2001, only 3% of people on the organ transplant waiting list and patients who had transplants were over 65, but in 2012, elderly patients represented nearly 18% of people on the waitlist and over 25% of people receiving transplants. The current debate poses the question: when the total number of adults was waiting for organ transplantation is increasing but organ donations remain steady, is it ethical to keep elderly patients on the top of the list?
In 2007, the United States suggested changes in the US donation systems that were designed to significantly alter the way that organs are distributed. Instead of the waiting list system, the proposed changes would match the youngest healthiest organs with the youngest healthiest patients, essentially making a value judgment about the worth of the lives of people depending on their ages and prioritizing young people over older patients who may have been on the waiting list longer (Crofut-Brittingham, 2007.) The director of the transplant surgery department at the Mayo Clinic in Phoenix, Arizona expressed the opinion that such a system would in actuality benefit all people, not just the younger transplant recipients. That view acknowledges that elderly people don’t need organs that would last as long as young people, so that the criteria for acceptable organs could be broadened, and that would contribute to alleviating the shortage of donated organs.
The implementation of such a system would create an unfair standard that would clearly discriminate against older people, according to critics of the proposal. These changes could inadvertently skew the pool of available organs by changing the pattern of people who are making living donations (Stein, 2011.) In addition, the new system would penalize middle-aged and older patients during a time when the current population is aging. According to these skeptics, the best kidneys are, for example, coming from young adults who are under 35 years of age; no one older than 50 would have an opportunity to receive one of those organs. The argument is that there are many people over the age of 50 who could have more than 20 years of life if they were to receive a properly functioning kidney; the new proposals would make it more difficult for them to receive a kidney that would last for that amount of time.
Regarding cultural issues and their impact on organ transplantation, certainly religions such as Christian Scientists and other cultural groups who do not practice traditional medicine might have objections to organ transplantation. Actually, the research that has been conducted regarding the positions of different religious groups demonstrates that the underlying attitude is usually that such donation is permissible unless the group has taken specific action to prohibit it (Theological Perspectives on Organ and Tissue Donations, 2013.) In fact, donating organs and tissue is typically viewed as a charitable act that is taken in order to save lives or enhance the quality of life, so that such activity does not call for any formal action by the group.
My belief is that organ transplantation should not be based on the age of the patient, but rather on the come first, served first basis. For example, decisions should also be based on the likelihood of the patient complying with after surgery changes such as giving up smoking, changing one’s diet, and behaving in other ways that would make this complex procedure a legitimate investment of resources. Those candidates may indeed be more likely to be the older patients, because they may have a much more immediate incentive to do whatever they can to extend their lives. Discriminating on the basis of age would seem to be a violation of the nursing code of ethics in my opinion.
- Crofut-Brittingham, A. (2007). Organ Transplantation. Retrieved from Mount Holyoke.edu: http://pub.mtholyoke.edu
- Span, P. (2013, January 8). Who Should Receive Organ Transplants? Retrieved from The New York Times: http://newoldage.blogs.nytimes.com
- Stein, R. (2011, February 24). Under Kidney Transplant Proposal, Younger Patients Would Get the Best Organs. Retrieved from The Washington Post: http://www.washingtonpost.com
- Theological Perspectives on Organ and Tissue Donation. (2013). Retrieved from United Network for Organ Sharing: http://www.unos.org