Last Monday, Martin Wilkinson, associate professor in the department of politics and international relations at the University of Auckland in New Zealand, gave a lecture in Griffin Hall on bioethics and organ allocation.
Wilkinson has both an undergraduate and doctoral degree from Oxford University, and is the author of numerous articles on public health ethics as well as the ethics of acquiring organs for transplantation. He has also been involved in policy-making, notably as chair of a ministerial advisory committee on biotethics.
The event was sponsored by the Oakley Center for Humanities and Social Sciences.
The discussion served as the Andrew B. Weiss Lecture on Medicine and Medical Ethics, an annual series that, according to the Oakley Center website, “promotes the discussion of medicine, including the economics of health care as well as biomedical and ethical issues.”
The lecture was two-pronged, first seeking to explain the ethical dilemmas of organ allocation generally and then focusing on the role of age in determining who is most deserving of the limited number of organs available for transplant.
After a short introduction by Julie Pedroni, lecturer in philosophy, Wilkinson began his lecture. He opened with a warning of the moral and logistical complexity of the issues he was planning to address in his lecture.
Quoting British philosopher Philippa Foot, Wilkinson said, “When you ask a philosopher a question, they talk for five minutes, and you no longer understand your own question.”
Wilkinson even admitted that he still gets confused despite having studied these issues for a majority of his professional career.
While there was a time in medical history that organ donation was considered, according to Wilkinson, “cowboy medicine,” it is now perceived as both safe and cost-effective.
However, “the master problem” is that there simply are not enough organs available for transplant. Thus, ethical issues arise when weighing the urgency, equity and potential benefits of the case. Wilkinson then explained how, over time, certain parameters have been set to determine who should get these limited numbers of organs.
For instance, “social worth prospects,” such as number of employees or membership in a church, are not taken into account. Patient responsibility is also not considered, even if, as Wilkinson playfully noted, “They smoked their lungs into becoming black as charcoal.”
Wilkinson also stated that people should not trust their first instincts with these complicated issues. For example, some people argue that transplants should be given to the individual with the absolute best biological match, and, therefore, the highest chance of long-term survival.
This strategy, however, puts ethnic minorities at a huge disadvantage, as the pool for better matches is exponentially smaller.
Thus, what seems to be a just system, in reality favors the majority. As Wilkinson said, “There are always ways to game the system.”
Wilkinson then posed a question: “Should age, ethically, make a difference in the organ allocation process? If so, how much weight should it have?”
According to Wilkinson, most countries give explicit priority to children, especially with regard to kidney transplants.
These countries have specific age cutoffs at which one’s chances of receiving a transplant immediately decrease. For instance, someone who is 17 may be much less likely to receive a transplant than someone who is 16.
Wilkinson sees these policies as “indefensible,” preferring a consistent decline in priority with age rather than drastic cutoffs.
Adding another layer to the already difficult issue, Wilkinson shared that transplants to patients aged 11 to 18 have some of the worst rates of success because “these patients wreck their new organs” by neglecting to take medications or abusing alcohol and other drugs.
The lecture was followed by a short question and answer period.