Will more organs save more lives? Cost-effectiveness and the ethics of expanding organ procurement

The assumption that procuring more organs will save more lives has inspired increasingly forceful calls to increase organ procurement. This project, in contrast, directly questions the premise that more organ transplantation means more lives saved. Its argument begins with the fact that resources are limited and medical procedures have opportunity costs. Because many other lifesaving interventions are more cost-effective than transplantation and compete with transplantation for a limited budget, spending on organ transplantation consumes resources that could have been used to save a greater number of other lives. This argument has not yet been advanced in debates over expanded procurement and could buttress existing concerns about expanded procurement. To support this argument, I review existing empirical data on the cost-effectiveness of transplantation and compare them to data on interventions for other illnesses. These data should motivate utilitarians and others whose primary goal is maximizing population-wide health benefits to doubt the merits of expanding organ procurement. I then consider two major objections: one makes the case that transplant candidates have a special claim to medical resources, and the other challenges the use of cost-effectiveness to set priorities. I argue that there is no reason to conclude that transplant candidates' medical interests should receive special priority, and that giving some consideration to cost-effectiveness in priority setting requires neither sweeping changes to overall health priorities nor the adoption of any specific, controversial metric for assessing cost-effectiveness. Before searching for more organs, we should first ensure the provision of cost-effective care.