Dear Joseph,
Right now, there is an enormous shortage of organs available for transplants. In consequence, as long as a suitable match is found, organs are assigned on a first-come, first-served basis, and there is no way you can be pushed to the top of the list unless you are near death. Something seems wrong about this system. I read that there was a great delay until Erma Bombeck, the great comic writer and definitely a national asset, was given a kidney transplant (and she died almost immediately thereafter). Shouldn't such a woman have been pushed to the top of the list?
--Puzzled and angry

Dear Puzzled,
Determining who should live and who should die on the basis of a person's fame or intellectual contribution to society is very tempting but not necessarily moral. Because I believe that human beings are created in God's image, I can't credit the idea that some people are made more in God's image than others. Even though I would prefer to see those who committed violent crimes pushed to the back of the list, I can't help thinking what horrible moral dilemmas would be unleashed if we awarded transplants on the basis of whose life was perceived by some committee to be more worthwhile.

	Organ Donation: Where Your Religion Stands By Gregg Easterbrook Hospital's Organ Program Is Unique One Boston hospital is taking a different approach to donation More Resources on Organ Donation and Allocation

For example, let's compare a 60-year-old philanthropist with a 10-year-old child. A lot of people would argue that the child should receive a transplant first, because she has so much of her life ahead. But another could counter that the 60-year-old has already proved himself to be a fine human being, whereas we have no such assurances about the 10-year-old. Or imagine, for that matter, trying to decide between two 10-year-olds. What criteria of character would you use? It seems to me that as long as we have an inadequate number of organs available for transplant, the current system probably makes sense.

(By the way, the more common rumor--that people with fame or wealth are given preference--turns out to be unfounded. Mickey Mantle, for instance, was not rushed to the head of the list for a liver transplant because he was a celebrity, but because he was the most ill person in his region of the country that day.)

	Organ Donation: Where Your Religion Stands By Gregg Easterbrook Hospital's Organ Program Is Unique One Boston hospital is taking a different approach to donation More Resources on Organ Donation and Allocation

There is, however, one change in the first-come, first-served standard that I think should be implemented. I suggest that those who volunteer to donate their undiseased organs in case of death be moved to the head of the list. If people knew that being a registered donor would greatly increase the likelihood of their receiving an organ if needed, I think we would see a great increase in the number of people making their organs available.

One objection that I've encountered to this proposal is that it might discriminate against those who, for religious reasons, are opposed to donating organs. True enough, but it does strike me as fair that those who oppose giving organs should be last when it comes to getting them. On a positive note, however, pushing potential donors to the top of the list might lead to such an increase in the number of available organs that everybody who needs an organ would get one.