Ethical analysis of arguments supporting the use of certain exclusion criteria in organ transplantation

The author analyses the arguments put forward by Eike Henner Kluge, in a paper entitled "Drawing the Ethical Line Between Organ Transplantation and Lifestyle Abuse" (CMAJ, 150 (5), 1994), supporting the idea that nicotine and alcohol abusers should not have an equal access to organ transplantation. Referring to an egalitarian justice, Kluge argues that one who has caused one's bad health condition should not be permitted to compete on the same basis as other candidates in order to have access to a scarce health care resource because in doing so one penalizes those who are not responsible for their bad health condition, diminishing their own chances of obtaining an available organ. After considering certain empirical facts in scarce health care resources, particularly in organ transplantation, the author defines the main characteristics of a just treatment in terms of an equal access to health care and demonstrates that Kluge's arguments are not supported by an egalitarian conception of justice. In fact, the proposed distribution of services is based on individual merit.