Scarce Goods: Justice, Fairness, and Organ Transplantation

We call it lifeboat ethics: When there is not enough of this or that scarce good, who should die that others might survive? Born in the 19th century, when shipwrecks were frequent and lifeboats scarce, it has become a 21st century dilemma. Who should get the last hospital bed, the scarce medical drug, the limited educational doctor, the needed transplantable human heart? Tom Koch considers both lifeboat ethics and its modern application to the distribution of transplantable human organs in the United States. He shows that the scarcity of organs is exacerbated where not created by racial and regional inequalities inherent in the American health care and transplant system. The real question, he concludes, is not "who should die" when there is not enough to go around, but the reasons why scarcity pervades at all.

TOM KOCH is a writer and bioethicist specializing in medical ethics. A frequent contributor to newspapers, magazines, and the CBC Radio, he is the author of 11 books./e Dr. Koch also is a forum associate at the David Lam Center, Simon Fraser University and an associate of the Center on Aging at The University of Hawaii.