Justice in Multi-Organ Transplantation

Multi-organ transplantation (MOT) raises a confounding moral question: Is it just to allocate two vital organs to a single patient when those two organs transplanted separately can save two patients? The US Organ Procurement and Transplantation Network (OPTN) allows organ allocation for MOT without fully explaining the rationale. That lacuna leaves clinicians and the public uncomfortably perplexed by the practice. This paper addresses the need for understanding the ethics of MOT. We begin by articulating the standard for justly allocating medical resources in clinical care, namely, provide each patient with the interventions needed to address their medical burdens. We also explicate the core concepts, "justice," "fairness," "equity," and "medical triage." Employing the example of patients with Fontan-related liver disease (FALD) who need simultaneous heart and liver transplant to survive, we argue that the widely endorsed concept of medical justice supports allocating organs for MOT.