Are geographic differences in transplantation inherently wrong?
OBJECTIVE
Geographic variation in liver transplantation has been the subject of extensive scrutiny, reflecting concerns that location is unfairly determinative for people needing organ transplantation. Drawing upon a number of established ethical approaches, we examine whether geographic differences in access to livers are inherently unethical.


RESULTS
We posit that the ethical imperative for redistribution largely hinges upon the belief that access to organs systematically disadvantages certain identifiable groups of patients over others. Yet, our data suggest that regions likely to be net-contributors may suffer from less access to transplantation and other health services, fewer social protections and greater burden of liver disease. Drawing upon a number of ethical approaches, including strict egalitarianism, utilitarianism, Maximin, Reciprocity, Sen's Impartial Spectator and a health equity framework, we demonstrate that the current proposal has significant weaknesses, and may not achieve its goals of improving equity and efficiency.


CONCLUSIONS
Formulating effective policies and programs to ameliorate health inequalities requires an understanding of the interrelated causes of mortality disparities and specific interventions to mitigate these causes. Although our analysis does not indicate how ethically distribute livers, but it suggests that this be done with consideration for population-based health measures.
aDepartments of Occupational Therapy and Community Health, Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, Massachusetts bVanderbilt Transplant Center and Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Keren
K
Ladin
Douglas W
DW
Hanto
D005843:Geography; D054625:Healthcare Disparities; D006801:Humans; D016031:Liver Transplantation / Q000592:standards*