Rationing Human Organs for Transplant

Abstract

Rationing is a ubiquitous element in health care allocation. The demand for health care is effectively infinite because the aspirations of modern medicine are utopian. Everyone must die, but doctors insist that any specifiable cause of death can be resisted and ultimately conquered. Demand is infinite but the supply of healers and the time for healing is limited, and so rationing must occur. However, rationing is a painful and unpleasant activity, and policymakers have a strong impulse to hide it if they cannot avoid it. Various methods are used. In the USA, health care is largely left to the market system, where public officials can pretend rationing does not occur or, if it does, it is not their responsibility. In other parts of the world, including Great Britain, public officials endeavor to ‘delegate’ rationing responsibility as far down the service delivery chain as possible — often to individual clinicians. In this way, decisions are made less visible, and the responsibility placed on professional caregivers. These and other techniques avoid the need to develop and defend explicit criteria for deciding who will receive care and, more importantly, who will not. Ambiguity, invisibility and complexity are characteristics of health care rationing and serve the important functions of diluting conflict and protecting policymakers from responsibility.