title: Survival lotteries reconsidered.
abstract: In 1975 John Harris envisaged a survival lottery to redistribute organs from one to a greater number in order to reduce number of deaths as a consequence of organ failure. In this paper I reach a conclusion about when running a survival lottery is permissible by looking at the reason prospective participants have for allowing the procedure from a contractual perspective. I identify three versions of the survival lottery. In a National Lottery, everyone within a jurisdiction is a candidate for being a donor for everyone else, disregarding all differences between individuals' eventual possibility of needing an organ. In a Group Specific Lottery, it is a question of running a lottery among members of a specific group who share the same probability of getting organ failure. In a Local Lottery one randomises among individuals who are already in need of a new organ but who happen to be compatible and in need of different organs. While the first is vulnerable to considerations of fairness, it is difficult to perceive a feasible way to implement the second option that does not come with a host of unwelcome consequences. I argue, however, that it is permissible to run Local Lotteries.
authors.affiliation: University of Melbourne, Melbourne. gerhardo@unimelb.edu.au
authors.forename: Gerhard
authors.initials: G
authors.lastname: Øverland
mesh_terms: D026689:Ethical Analysis; D005260:Female; D005715:Gambling; D015276:Health Care Rationing / Q000941:ethics* / Q000379:methods; D006708:Homicide / Q000941:ethics*; D006801:Humans; D008297:Male; D010686:Philosophy, Medical; D011336:Probability; D012935:Social Justice / Q000941:ethics*; D016019:Survival Analysis; D019452:Terminally Ill / Q000523:psychology*; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000941:ethics* / Q000379:methods; D019737:Transplants / Q000600:supply & distribution*; D026712:Value of Life; D014850:Waiting Lists