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by Olivia Bredbenner

Created on: July 10, 2011   Last Updated: July 22, 2011

Should age -based rationing be a consideration for organ transplant ?  The USA has long benefited from some of the most advanced and sophisticated technology in heath care and its delivery. However, our better health and our longevity has now lead us to even more financial and ethical dilemmas.

Much has been debated on the possibility of rationing health care as a means of maintaining our standards in the heath care system, and reducing the cost that has now become so prohibitive. This is especially so in the area of organ recipients where our advances are still going forward.

According to the CEJA-Council of Ethical and Judicial Affairs, principles of medical ethics are developed through a deliberative process and go through continual refinement. This “code” serves as a guide for physicians to strive to practice ethically. These are not laws but standards of conduct that define honorable behavior for physicians.

In the area of age-based rationing the ethical dilemma became more complex. In the most costly areas of care such as organ transplantation or renal dialysis. Any decisions regarding which age would be applied in the criteria are in conflict with our society's definition of “social worth.” “Therefore in order to be fair, it would have to be applied across all classes without discrimination.”

It was briefly thought that after deliberation the outcome would be that our society would come to sound conclusions, and then, would be able to provide less costly health care over all. It was however,after much deliberation, recognized that major flaws existed in this rationale. “ Although in our aging population of those over 65 there are many that have declining health, limited mobility and are less productive.

There are also other's that are in good health , active and needed within our society.” “ Many of those are our heads of state, scholars, scientists, philosophers, religious leaders, writers, artists, musicians. This included about 81,000 physicians who were alive and active during this deliberation in 1986.”

To go further it was said . The idea of anyone establishing another's social worth , including age based rationing is morally repugnant and was pointed out to be a method devised by Nazi Germany— during the Holocaust.

Organ transplant recipients are prescreened, counseled and prepared for their surgery. This includes education in lifestyle and self care. Across the population those that care for themselves and had a good support system most often did well regardless of their age. Ruling out a candidate for an organ transplant because of age should not be the first consideration.

According to CEJA ..”If it is appropriate to limit availability of scarce health resources to patients who are terminally ill or who have a small chance of recovery, this concept should be explored as a means of reducing expenditures in health care if it is determined that rationing is necessary. However, choices based solely on chronological age are not acceptable.”

1988 American Medical Association  All rights reserved

Seigel, J. Taeuber, C. demographic Perspectives on the Long-Lived-Society.  Daedalus

Roback, G. et al.{eds}: Physician Characteristics and Distribution in the U.S. 1987

Wetle, T. Age as a risk factor for inadequate treatment. Jama 1987; 258:516

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