A priority system is one in which previously registered donors receive a preference in the allocation of organs for transplant ahead of those who have not registered. Supporters justify these systems on the basis that they are fair and will encourage donor registration. This article reviews existing studies of public reactions to priority systems, as well as studies of the extent to which the moral principle of reciprocity affects decision making in organ donation. The role of reciprocity in the public discourse surrounding the enactment of priority systems in Singapore and Israel is described. One factor that seems to have been relevant in these countries is the existence of a religious minority that is perceived as willing to take an organ but not to donate one. Although this perception may have fueled a resentment of perceived “free-riders,” concerns were raised about the social divisiveness of priority systems. In sum, people appear to be sensitive to the principle of reciprocity in the context of organ donation, but this sensitivity does not always translate into support for priority systems. Further research into whether public messaging about organ donation could be modified to encourage registration by appeal to the golden rule would be worthwhile.
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References
1.
SchwindtRViningAR. Proposal for a future delivery market for transplant organs. J Health Polit Policy Law.1986;11(3):483–500.
2.
PetersDA. A unified approach to organ donor recruitment, organ procurement, and distribution. J Law Health.1988–1989;3(2):157–187.
3.
CapronAM. More blessed to give than to receive?Transplant Proc.1992;24(5):2185–2187.
4.
LeinmanILowyFH. Ethical considerations in living organ donation and a new approach: An advance-directive organ registry. Arch Intern Med.1992;152(7):1484–1488.
5.
MuyskensJ.Should receiving depend upon willingness to give?Transplant Proc.1992;24(5):2181–2184.
GillonR.On giving preference to prior volunteers when allocating organs for transplantation. J Med Ethics.1995;21(4):195–196.
8.
JarvisR.Join the club: A modest proposal to increase availability of donor organs. J Med Ethics.1995;21(4):199–204.
9.
GubernatisG.Solidarity model as nonmonetary incentive could increase organ donation and justice in organ allocation at the same time. Transplant Proc.1997;29(8):3264–3266.
10.
EatonS.The subtle politics of organ donation: A proposal. J Med Ethics.1998;24(3):166–170.
11.
SchwindtRViningA.Proposal for a mutual insurance pool for transplant organs. J Health Polit Policy Law.1998; 23(5):725–741.
12.
DaarAS. Altruism and reciprocity in organ donation: Compatible or not?Transplantation.2000;70(4):704–705.
13.
SellsRA. Donation: Will the principle of “do as you would be done by” be enough?Transplantation.2000;70(4):703–704.
14.
KlugeEH. Improving organ retrieval rates: Various proposals and their ethical validity. Health Care Anal.2000;8(3):279–295.
15.
GubernatisGKliemtH.A superior approach to organ allocation and donation. Transplantation.2000;70(4):699–702.
16.
GubernatisGKliemtH.Solidarity model: A way to cope with rationing problems in organ transplantation. Transpl Int.2000;13(suppl 1):S607–S608.
17.
KolberAJ. A matter of priority: Transplanting organs preferentially to registered donors. Rutgers Law Rev.2003;55(3):671–740.
WigmoreSJForsytheJL. Incentives to promote organ donation. Transplantation.2004;77(1):159–161.
20.
Sackner-BernsteinJDGodinS.Increasing organ transplantation—fairly. Transplantation.2004;77(1):157–159.
21.
SteinbergD.An “opting-in” paradigm for kidney transplantation. Am J Bioeth.2004;4(4):4–14.
22.
RavelingienAKromA.Earning points for moral behavior: Organ allocation based on reciprocity. Int J Appl Philos.2005;19(1):73–83.
23.
NadelMSNadelCA. Using reciprocity to motivate organ donations. Yale J Health Policy Law Ethics.2005;5(1):293–325.
24.
GilesS.An antidote to the emerging two tier organ donation policy in Canada: The Public Cadaveric Organ Donation Program. J Med Ethics.2005;31(4):188–191.
25.
ChandlerJA. Priority systems in the allocation of organs for transplant: Should we reward those who have previously agreed to donate?Health Law J.2005;13:99–138.
26.
SpitalA.Should people who commit themselves to organ donation be granted preferred status to receive organ transplants?Clin Transplant.2005;19(2):269–272.
27.
UndisDJ. Changing organ allocation will increase organ supply. DePaul Law Rev.2005–2006;55:889–896.
28.
ChildressJFLivermanCT, eds, for the Committee on Increasing Rates of Organ Donation, Board on Health Sciences Policy, Institute of Medicine. Organ Donation: Opportunities for Action.Washington DC: National Academies Press; 2006.
29.
BramstedtKA. Is it ethical to prioritize patients for organ allocation according to their values about organ donation?Prog Transplant.2006;16(2):170–174.
30.
LandryDW. Voluntary reciprocal altruism: A novel strategy to encourage deceased organ donation. Kidney Int.2006; 69(6):957–959.
31.
MurphyTFVeatchRM. Members first: The ethics of donating organs and tissues to groups. Camb Q Healthc Ethics.2006;15(1):50–59.
32.
SiegalGBonnieRJ. Closing the organ gap: A reciprocity-based social contract approach. J Law Med Ethics.2006; 34(2):415–423.
33.
RobertsonCT. From free riders to fairness: A cooperative system for organ transplantation. Jurimetrics.2007;48(1):1–42.
34.
TrotterG.Preferred allocation for registered organ donors. Transplant Rev.2008;22(3):158–162.
35.
GruenbaumBFJotkowitzA.The practical, moral, and ethical considerations of the new Israeli law for the allocation of donor organs. Transplant Proc.2010;42(10):4475–4478.
Den HartoghG.Priority to registered donors on the waiting list for postmortal organs? A critical look at the objections. J Med Ethics.2011;37(3):149–152.
38.
GuttmanNAshkenaziTGesser-EdelsburgASeidmannV.Laypeople's ethical concerns about a new Israeli organ transplantation prioritization policy aimed to encourage organ donor registration among the public. J Health Polit Policy Law.2011;36(4):691–716.
39.
WattlesJ.The Golden Rule.New York, NY: Oxford University Press; 1996.
40.
PfaffDW. The Neuroscience of Fair Play: Why We (Usually) Follow the Golden Rule.New York, NY: Dana Press; 2007.
41.
GoeringSDulaA.Reasonable people, double jeopardy and justice. Am J Bioeth.2004;4(4):37–39.
42.
AitaK.New organ transplant policies in Japan, including the family-oriented priority donation clause. Transplantation.2011;91(5):489–491.
43.
KitturDSHoganMMThukralVKMcGawLJAlexanderJW. Incentives for organ donation? The United Network for Organ Sharing Ad hoc Donations Committee. Lancet.1991;338(8780):1441–1443.
44.
JasperJDNickersonCAHersheyJCAschDA. The public's attitudes toward incentives for organ donation. Transplant Proc.1999;31(5):2181–2184.
45.
AhlertMGubernatisGKleinR.Common sense in organ allocation. Analyse Kritik.2001;23:221–244.
46.
BennettRSavaniS.Factors influencing the willingness to donate body parts for transplantation. J Health Soc Policy.2004;18(3):61–85.
47.
DeckerOWinterMBrahlerEBeutelM.Between commodification and altruism: Gender imbalance and attitudes towards organ donation. A representative survey of the German community. J Gender Stud.2008;17(3):251–255.
48.
LaveeJAshkenaziTGurmanGSteinbergD.A new law for allocation of donor organs in Israel. Lancet.2010;375(9720):1131–1133.
49.
StijnenMMNDijkerAJM. Reciprocity and need in posthumous organ donation: The mediating role of moral emotions. Soc Psychol Personal Sci.2011;2(4):387–394.
50.
OzMCKheraniARRoweA. How to improve organ donation: Results of the ISHLT/FACT poll. J Heart Lung Transplant.2003;22(4):389–410.
51.
SiminoffLAMercerMB. Public policy, public opinion, and consent for organ donation. Camb Q Healthc Ethics.2001;10(4):377–386.
52.
BattenHLProttasJM. Kind strangers: The families of organ donors. Health Affairs.1987;6(2):35–47.
53.
PetersTGKitturDSMcGawLJRoyMRNelsonEW. Organ donors and nondonors: An American dilemma. Arch Intern Med.1996;156(21):2419–2424.
54.
BoulwareLETrollMUWangNYPoweNR. Public attitudes toward incentives for organ donation: A national study of different racial/ethnic and income groups. Am J Transplant.2006;6(11):2774–2785.
55.
JasperJDNickersonCAUbelPAAschDA. Altruism, incentives, and organ donation: Attitudes of the transplant community. Med Care.2004;42(4):378–386.
56.
Gandalf Group, for the Trillium Gift of Life Network. Public Opinion Research for a Campaign to Promote Registration.2009. http://www.giftoflife.on.ca. Accessed April 29, 2012.
57.
SchwedaMSchicktanzS.Public ideas and values concerning the commercialization of organ donation in four European countries. Soc Sci Med.2009;68(6):1129–1136.
58.
SchwedaMWohlkeSSchicktanzS.Understanding public skepticism toward organ donation and its commercialization: The important role of reciprocity. Transplant Proc.2009;41(6):2509–2511.
SchmidtVHLimCH. Organ transplantation in Singapore: History, problems and policies. Soc Sci Med.2004;59(10):2173–2182.
62.
TeoB.Organs for transplantation: The Singapore experience. Hastings Cent Rep.1991;21(6):10–13.
63.
IyerTK. Kidneys for transplant—“opting out” law in Singapore. Forensic Sci Int.1987;35(2–3):131–140.
64.
Singapore, Sixth Parliament, 2nd Session. Report of the Select Committee on the Human Organ Transplant Bill (Bill No. 26/86) Presented to Parliament on 22 April 1987.Singapore: Singapore National Printers; 1987.
65.
Tan EKB. Keeping God in place: The management of religion in Singapore. In: LaiAE, ed. Religious Diversity in Singapore.Singapore: Institute of Southeast Asian Studies; 2008: 55–82.
66.
BakarAbu M.NKF: “Our resources are being drained.”The Straits Times. September 23, 1993:5.
67.
BakarAbuM.Include Muslims in organ transplant act. The Straits Times. September 23, 1993:L4.
68.
NirmalaM.Muslims must give kidney issue top priority: Abdullah. The Straits Times. January 30, 1994:23.
69.
NirmalaM.Don't let prejudices undermine Muslim community's needs. The Straits Times. February 20, 1994:16.
70.
NgJ.Include us in transplant act: Muslims. The Straits Times. January 31, 2003.
HellerA.In Israel, a radical way to boost organ supply: Experiment aims to broaden donor pool by enforcing the “Golden Rule.”Associated Press. March 14, 2010. http://www.msnbc.msn.com/id/35842049/ns/health-health_care. Accessed March 3, 2012.
RodrigueJRCornellDLHowardRJ. Relationship of exposure to organ donation information to attitudes, beliefs, and donation decisions of next of kin. Prog Transplant.2009;19(2):173–179.
77.
MorganMMayblinMJonesR.Ethnicity and registration as a kidney donor: The significance of identity and belonging. Soc Sci Med.2008;66(1):147–158.
78.
PadelaAIRasheedSWarrenGJChoiHMathurAK. Factors associated with positive attitudes toward organ donation in Arab Americans. Clin Transplant.2011;25(5):800–808.
