The allocation of organs donated by altruistic strangers

In many transplant centers, organ retrieval from altruistic strangers is accepted practice; patients use Internet Web sites and other public media to locate strangers willing to give them an organ. It is argued that altruistic strangers should be permitted to select the recipients of their organs because 1) personal relationships are morally important; 2) it increases the number of available organs; and 3) no one is hurt by the process. Nonetheless, using public media to obtain organs may undermine equity in organ allocation. Organs donated by altruistic strangers do not go necessarily to patients who have the best immunologic match or the most urgent need or who have waited the longest. A publicly chartered organization should be established to coordinate live organ donation, including donation by altruistic strangers. Altruistic strangers should be educated to allocate their donated organs according to a prudent balance of equity and utility rather than their emotional response to a particular patient's plight, identity, or circumstances.