Theoretical Medicine

, Volume 13, Issue 4, pp 337–347 | Cite as

Organ transplants, foreign nationals, and the free rider problem

  • Dena S. Davis
Special Articles

Abstract

There is strong sentiment for a policy which would exclude foreigners from access to organs from American cadaver donors. One common argument is that foreigners are ‘free riders’; since they are not members of the community whichgives organs, it would be unfair to allow them toreceive such a scarce resource.

This essay examines the philosophical basis for the free rider argument, and compares that with the empirical data about organ donation in the U.S. The free rider argument ought not to be used to exclude foreign nationals because it is based on fallacious assumptions about group membership, and how the ‘giving community’ is defined. Polls show that even among the seventy-five per cent of Americans who support organ donation, only seventeen per cent had taken the small step of filling out donor cards. Therefore, it goes against logic to define the giving community as coextensive with American residency, while excluding foreigners who might well have become donors had they lived in countries which provided that option.

Key words

free rider argument foreign nationals organ allocation 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kolata G. Organ shortage clouds new transplant era.Science 1983;221:32–3.Google Scholar
  2. 2.
    The National Organ Procurement and Transplantation Network.UNOS Policies Regarding Transplantation of Foreign Nationals and Exportation and Importation of Organs. Richmond, VA: United Network for Organ Sharing, 1988.Google Scholar
  3. 3.
    Anonymous. Favoritism shrouds presby transplants.The Pittsburgh Press 1985 May 12.Google Scholar
  4. 4.
    Anonymous. Kidney patients' families protest favoritism in transplant choices.The Pittsburgh Press 1985 May 14.Google Scholar
  5. 5.
    Anonymous. Organ-giving policy gets scrutiny.The Pittsburgh Press 1985 May 14.Google Scholar
  6. 6.
    Evans R, Manninen DL. U.S. public opinion concerning the procurement and distribution of donor organs.Transplant Proc 1982;20:781–5.Google Scholar
  7. 7.
    Williams GM, Ferree D, Bollinger RR, LeFor WM. Reasons why kidneys removed for transplantation are not transplanted in the United States.Transplantation 1984;38:691–4.Google Scholar
  8. 8.
    U.S. Department of Health and Human Services.Organ Transplantation: Issues and Recommendations (Report of the Task Force on Organ Transplantation. Washington, DC: US Government Printing Office, 1986.Google Scholar
  9. 9.
    U.S. Department of Health and Human Services, Office of the Inspector General.The Access of Foreign Nationals to U.S. Cadaver Organs. Washington, DC: US Government Printing Office, 1986.Google Scholar
  10. 10.
    Prottas JM. Nonresident aliens and access to organ transplants.Transplant Proc 1989;21:3426–9.Google Scholar
  11. 11.
    The National Organ Procurement and Transplantation Network.Final Statement of Policy: UNOS Policy Regarding Utilization of the Point System for Cadaveric Kidney Allocation. Richmond, VA: United Network for Organ Sharing, 1989.Google Scholar
  12. 12.
    Cleveland Clinic Foundation Ethics Committee.Draft Document on Transplantation of Non-Immigrant Aliens. Cleveland, OH: Cleveland Clinic Foundation Ethics Committee, 1989.Google Scholar
  13. 13.
    Simmons JA.Moral Principles and Political Obligations. Princeton, NJ: Princeton University Press, 1979.Google Scholar
  14. 14.
    Nozick R.Anarchy, State and Utopia. New York: Basic Books, Inc, 1974.Google Scholar
  15. 15.
    Kajikawa K. Japan: a new filed emerges.Hastings Cent Rep 1989;19(Special Suppl):29–30.Google Scholar
  16. 16.
    Prottas JM. In organ transplants, Americans first?Hastings Cent Rep 1986;16:23–4.Google Scholar
  17. 17.
    Walzer M.Spheres of Justice. New York: Basic Books, Inc, 1983.Google Scholar
  18. 18.
    Nickel J. Should undocumented aliens be entitled to health care?Hastings Cent Rep 1986;16:19–23.Google Scholar
  19. 19.
    Silver T. The case for a post-mortem organ draft and a proposed model organ draft act.Boston University Law Review 1988;68:681–728.Google Scholar
  20. 20.
    Prottas JM, Batten HL. The willingness to give: the public and the supply of transplantable organs.J. Health Polit Policy Law 1991;16(Spring):121–34.Google Scholar
  21. 21.
    Ramsey P.The Patient as Person. New Haven, CT: Yale University Press, 1970.Google Scholar
  22. 22.
    May WF.The Patient's Ordeal. Bloomington, IN: Indiana University Press, 1991.Google Scholar
  23. 23.
    Schwartz R. Grubb A. Why Britain can't afford informed consent.Hastings Cent Rep 1985;15:19–25.Google Scholar
  24. 24.
    Evans R. Public perception and the realities of organ transplantation.Michigan Hospitals 1987;23:13–18.Google Scholar
  25. 25.
    Kilner J.Who Lives? Who Dies? Ethical Criteria in Patient Selection. New Haven, CT: Yale University Press, 1990.Google Scholar
  26. 26.
    Gruson L. Some doctors move to bar transplants to foreign patients.The New York Times 1985; Aug 10:1 (col 4).Google Scholar
  27. 27.
    Callender C. Organ donation in the black population: where do we go from here?Transportat Proc 1987;19:36–40.Google Scholar

Copyright information

© Kluwer Academic Publishers 1992

Authors and Affiliations

  • Dena S. Davis
    • 1
  1. 1.Cleveland-Marshall College of LawClevelandUSA

Personalised recommendations