Nonresident aliens and access to organ transplant.

The present policies for allowing nonresident aliens access to organ transplantation are neither fair nor consistent. They apply only to some transplants, and they take no account of their discriminatory effect among foreigners. Much less do they deal with the meaning of fair access, given our complete ignorance of the number and character of those outside the United States in need of a transplant. Most strikingly, present policy prohibits discrimination based on where a patient lives in part by imposing it based on where the patient is to receive a transplant, here or abroad. The one-list policy is more a result of political compromise, institutional interest, and the misapplication of the principle of professional autonomy than of any consistent policy or logic. In this mishmash of justification, one argument does stand out--that sharing organs with nonresidents ought to be done on the grounds of charity. Yet even here, the present form of this position is inadequate, perhaps because it has not been systematically applied to organ distribution issues. An argument for charity contains two elements, the nature of the obligation and the subject on whom the obligation rests. In its ordinary form, the obligation of charity requires a transfer of resources from wealth to poverty. A more subtle and complex formulation is required to apply this obligation to the conditions of universal poverty pertaining in organ transplantation. It remains to be seen if this is possible. There is also the question of to whom the argument must be made. A minimal requirement of charity is that one shares one's own resources, not those of another. Inevitably, this brings us to the perennial question of organ distribution: Whose organs are these? We can easily say whose they are not; they do not belong to hospital administrators, academic researchers, transplant surgeons, or organ procurement agencies. Insofar as they are national resources, Congress may be able to stake a claim; but insofar as giving organs to nonresident imposes sacrifices on residents awaiting an organ, perhaps they should be consulted. And their right to refuse must be accepted, for in organ distribution, the only real charity the well have a right to dispense is not to judge the sick.