Medical ethics and economics of organ transplantation.

Should organ transplants be available to all, regardless of ability to pay? Are organ transplants diverting funds from other, more basic medical needs? These are some of the economic questions of transplantation facing the medical profession and society in general. With the development of dialysis in the 1960s came the agonizing question of who should benefit from the limited number of kidney machines. This was resolved in 1972 when Congress extended Medicare benefits to patients with end-stage renal disease who were not federal employees or covered by VA benefits. But the economic fallout from the costs of such treatment underlies much of the reluctance to make access to heart and liver transplants available to everyone who would benefit from them. Some argue that if kidney transplants are available to all regardless of ability to pay, why should the same not be true of heart and liver transplants? The counterargument favors other uses for the funds, such as investing in basic research, education, and other preventive strategies and meeting the basic health needs of the uninsured. One argument for equal access to transplantation is that organs are donated for the good of the public as a whole, not just for those who can afford the operations, and that individuals and their families are asked to donate organs regardless of their financial status. Therefore, if organs are to be regarded as a public resource, they should be available to all, regardless of ability to pay.