World Journal of Surgery

, Volume 38, Issue 7, pp 1650–1657 | Cite as

Organ Shortage: The Greatest Challenge Facing Transplant Medicine

  • David ShafranEmail author
  • Eric Kodish
  • Andreas Tzakis


The success of organ transplantation as a treatment for end-stage organ disease has yielded a series of ethical quandaries originating from the issue of organ shortage. Scarcity of organs for transplantation necessitates formulation of just and fair allocation policies as well as ethically viable solutions to bridging the vast gap between organ supply and demand. The concept of “triage” provides a useful paradigm in which to contextualize the organ shortage issue. This entails subjugating the welfare of the individual patient for the benefit of the wider community as an ethically justified response to the challenge of scarcity.


Organ Donation Brain Death Allocation Policy Donation After Cardiac Death Organ Shortage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.


  1. 1.
    Rescher N (1969) The allocation of exotic medical lifesaving therapy. Ethics 79:173–186CrossRefGoogle Scholar
  2. 2.
    Rhodes R, Miller C, Schwartz M (1992) Transplant recipient selection: peacetime vs. wartime triage. Camb Q Healthc Eth 1(4):327–331CrossRefGoogle Scholar
  3. 3.
    Iserson KV, Moskop JC (2007) Triage in medicine, part I: concept, history, and types. Ann Emerg Med 49:275–281PubMedCrossRefGoogle Scholar
  4. 4.
    Moskop JC, Iserson KV (2007) Triage in medicine, part II: underlying values and principles. Ann Emerg Med 49:282–287PubMedCrossRefGoogle Scholar
  5. 5.
    Beauchamp TL, Childress JF (2008) Principles of biomedical ethics, 6th edn. Oxford University Press, OxfordGoogle Scholar
  6. 6.
    Organ Procurement and Transplant Network (OPTN), Health Resources and Services Administration, U.S. Department of Health and Human Services, Policy Management, Public Comment.
  7. 7.
    Colvin-Adams M, Valapour M, Hertz M, Heubner B, Paulson K, Dhungel V, Skeans MA, Edwards L, Ghimire V, Waller C, Cherikh WS, Kasiske BL, Snyder JJ, Israni AK (2012) Lung and heart allocation in the United States. Am J Transpl 12:3213–3234CrossRefGoogle Scholar
  8. 8.
    Smith JM, Biggins SW, Haselby DG, Kim WR et al (2012) Kidney, pancreas and liver allocation and distribution in the United States. Am J Transpl 12:3191–3212CrossRefGoogle Scholar
  9. 9.
    Egan TM, Murray S, Bustami RT, Shearon TH et al (2006) Development of the new lung allocation system in the United States. Am J Transpl 6:1212–1227CrossRefGoogle Scholar
  10. 10.
    Stiller C (2004) Organ transplants, medical overview of. In: Post SG (ed) Encyclopedia of bioethics, 3rd edn. Macmillan Reference, New York, pp 1944–1953Google Scholar
  11. 11.
    United Network for Organ Sharing. Accessed May 2013
  12. 12.
    Scientific Registry for Transplant Recipients. Accessed Sept 2013
  13. 13.
    Organ Procurement and Transplantation Network (OPTN), Health Resources and Services Administration, U.S. Department of Health & Human Services. Accessed 12 April 2013
  14. 14.
    National Kidney and Urologic Diseases Information Clearinghouse, Kidney Disease Statistics for the United States. Accessed 6 April 2013
  15. 15.
    Global Observatory on Donation and Transplantation, 2011 Activity Report. Accessed Nov 2013
  16. 16.
    McCarrick PM (1995) Organ transplant allocation. Kennedy Inst Eth J 5(4):365–384CrossRefGoogle Scholar
  17. 17.
    Institute of Medicine, Committee on Organ Procurement and Transplantation Policy, Division of Health Sciences Policy (1999) Organ procurement and transplantation. National Academy Press, Washington, DCGoogle Scholar
  18. 18.
    Egan TM (2003) Ethical issues in thoracic organ distribution for transplant. Am J Transpl 3:366–372CrossRefGoogle Scholar
  19. 19.
    Vella JP, Cohen DJ (2013) Transplantation. Nephrol Self Assess Program 12(5):315–317.
  20. 20.
    Persad G, Wertheimer A, Emanuel EJ (2009) Principles for allocation of scarce medical interventions. Lancet 373:423–431PubMedCrossRefGoogle Scholar
  21. 21.
    Childress J (1996) The gift of life: ethical issues in organ transplantation. Bull Am Coll Surg 81:8–22PubMedGoogle Scholar
  22. 22.
    Miller FG, Troug RD (2012) Death, dying, and organ transplantation: reconstructing medical ethics at the end of life. Oxford University Press, OxfordGoogle Scholar
  23. 23.
    Asai A, Kadooka Y, Aizawa K (2012) Arguments against promoting organ transplants from brain-dead donors, and views of contemporary Japanese on life and death. Bioethics 26:215–223PubMedCrossRefGoogle Scholar
  24. 24.
    Egawa H, Tanabe K, Fukushima N, Date H et al (2012) Current status of organ transplantation in Japan. Am J Transpl 12:523–530CrossRefGoogle Scholar
  25. 25.
    Siminoff LA, Agyemang AA, Traino HM (2013) Consent to organ donation: a review. Progr Transpl 23:99–104CrossRefGoogle Scholar
  26. 26.
    Shafer TJ, Wagner D, Chessare J, Schall MW et al (2008) US organ donation breakthrough collaborative increases organ donation. Crit Care Nurs Q 31:190–210PubMedCrossRefGoogle Scholar
  27. 27.
    Abouna GM (2008) Organ shortage crisis: problems and possible solutions. Transpl Proc 40:34–38CrossRefGoogle Scholar
  28. 28.
    Weber M, Dindo D, Demartines N, Ambuhl PM, Clavien PA (2002) Kidney transplantation from donors without a heartbeat. N Engl J Med 347:248–255PubMedCrossRefGoogle Scholar
  29. 29.
    Voo TC, Campbell AV, de Castro LD (2009) The Ethics of organ transplantation: shortages and strategies. Ann Acad Med 38:359–364Google Scholar
  30. 30.
    English V, Wright L (2007) Is presumed consent the answer to organ shortages? BMJ 334:1088–1089PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Quigley M, Brazier M, Chadwick R, Michel MN, Paredes D (2008) The organs crisis and the Spanish model: theoretical versus pragmatic considerations. J Med Eth 34:223–224CrossRefGoogle Scholar
  32. 32.
    Childress JF, Liverman CT (eds) Committee on Increasing Rates of Organ Donation; Board on Health Sciences Policy; Institute of Medicine, (2006) Organ Donation: Opportunities for Action. The National Academies Press, Washington, DCGoogle Scholar
  33. 33.
    Robertson CT (2007) From free riders to fairness: a cooperative system for organ transplantation. Jurimetr J 48:1–41Google Scholar
  34. 34.
    U.S. Department of Health and Human Services, Public Health Service, Health Resources and Services Administration, Office of Organ Transplantation (1986) Organ transplantation: issues and recommendations. Report of the task force on organ transplantation. HRSA, Washington, DCGoogle Scholar
  35. 35.
    Organ Procurement and Transplantation Network (OPTN), Health Resources and Services Administration, U.S. Department of Health & Human Services. Accessed 12 Nov 2013
  36. 36.
    Garonzik-Wang JM, Berger JC, Ros RL, Kucirka LM, Deshpande NA, Boyarsky BJ, Montgomery RA, Hall EC, James NT, Segev DL (2012) Live donor champion: finding live kidney donors by separating the advocate from the patient. Transplantation 93:1147–1150PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Ross LF, Rubin DT, Siegler M, Josephson MA, Thistlethwaite JR Jr, Woodle ES (1997) Ethics of paired-kidney-exchange program. N Engl J Med 336:1752–1755PubMedCrossRefGoogle Scholar
  38. 38.
    El Nahas AM, Bello AK (2005) Chronic kidney disease: the global challenge. Lancet 365:331–340CrossRefGoogle Scholar
  39. 39.
    Quraishi A (2004) Pakistan’s lucrative kidney trade, CNN, August 4, 2004. Accessed 30 April 2013
  40. 40.
    Gentleman A (2008) Kidney thefts shock India, The New York Times, January 30, 2008. Accessed 4 Jan 2013
  41. 41.
    World Health Organization guiding principles of human cell, tissue, and organ transplantation. Resolution WHA63.22 (63rd World Health Assembly) May 2010.
  42. 42.
    Paul PJ II (1995) Evangelium Vitae. Encyclical letter on the value and inviolability of human life, March 25, 1995.
  43. 43.
    Participants in the International Summit on Transplant Tourism and Organ Trafficking Convened by the Transplantation Society and International Society of Nephrology in Istanbul, Turkey, April 30–May 2, 2008 (2008) The declaration of Istanbul on organ trafficking and transplant tourism. Transplantation 86(8):1013–1018Google Scholar
  44. 44.
    Jafar TH (2009) Organ trafficking: global solutions for a global problem. Am J Kidney Dis 54(6):1145–1157PubMedCrossRefGoogle Scholar
  45. 45.
    Inston NG, Gill D, Al-Hakim A, Ready AR (2005) Living paid organ transplantation results in unacceptably high recipient morbidity and mortality. Transpl Proc 37(2):560–562CrossRefGoogle Scholar
  46. 46.
    Barsoum RS (2008) Trends in unrelated-donor kidney transplantation in the developing world. Pediatr Nephrol 23(11):1925–1929PubMedCrossRefGoogle Scholar
  47. 47.
    Ghods AS, Savaj S (2006) Iranian model of paid and regulated living-unrelated kidney donation. Clin J Am Soc Nephrol 1:1136–1145PubMedCrossRefGoogle Scholar
  48. 48.
    Matas A (2005) Living kidney donation: Controversies and realities. The case for a regulated system of living kidney sales. Program and Abstracts of the American Transplant Congress 2005: 6th annual joint meeting of the American Society of Transplant Surgeons and the American Society of Transplantation, Seattle, WA, May 21–25, 2005Google Scholar
  49. 49.
    Matas AJ (2006) Why we should develop a regulated system of kidney sales: a call for action! Clin J Am Soc Nephrol 1:1129–1132PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  1. 1.Department of Bioethics and the Transplant CenterCleveland ClinicClevelandUSA

Personalised recommendations