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By Jennifer Lahl

Today’s LA Times is covering a story on four Japanese gang figures who received liver transplants at UCLA. The story raises all of the ethical issues surrounding organ donation and transplantation. How do we ethically share organs which are scarce and precious and needed for saving lives?

Access to organs has always raised ethical problems. Who is our neighbor, and how far do we need to open our borders and let people into the donor pool? The story states that these were Japanese bad dudes and one in particular, Tadamasa Goto, was allowed into the states in exchange for leads and information on Japanese criminal gangs. While here, he was in need of a liver transplant and the story goes that he “got a liver and was laughing back to where he came from.” Laughing mainly because in exchange for useless information he got away with a life saving liver transplant. He took cuts and jumped the line.

Who’s worthy of the much needed organ has also been part of the debate. Does the alcoholic in need of a liver transplant get put to the bottom of the list over a person who’s had a chronic liver disease from birth? Or in this case, does the law abiding citizen get to move to the head of the line over the law breaker? The argument has often been that the system needs to be blind to criteria of worth because this is so subjective and slides us into suggesting people have a duty or obligation to die because their life is not worth living or their life is not worth saving. We certainly wouldn’t suggest the converse. That we begin killing those on death row for their organs. Often blind lotteries are suggested after the medical criteria has been assessed. Does the organ match the recipient? When directly competing for the much needed organ, all things being equal, who needs the transplant most urgently?

And this debate often boils down to a discussion on the allocation of scarce resources. Fact is, we don’t have enough organs to meet the needs of those waiting on lists for a transplant. This story states that 100 people died waiting on the list, while the bad guys got away with organs. So how do we divvy them up fairly?

What often makes people really queasy is just feeling that the current organ donation program isn’t fair. Justice matters. One comment in the LA Times piece states what many people feel. They’ve chosen to opt out of the DMV pink dot organ donor program because the system is corrupt. The United Network of Organ Sharing should take notice that ethics do matter and that people do have an innate sense of injustice. Once the ethics are shored up, public confidence will be restored and people will probably be glad to put that pink dot back on their license.

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