Organ allocation for transplantation: relations between equity concepts and ethical principles

Democratic and liberal societies must consider justice and equity in their distributions, chiefly in a context of social and economic inequality. Principles of distributive justice are stressed to their limits in life and death situations such as organ allocation for transplantation. This article addresses theoretical aspects of the equity and health equity concepts and tries to relate them to ethical principles used to guide the selection of allocation criteria. In order to identify desirable structural elements of a fair allocation system, the following were analyzed: John Rawls’ theory of justice as fairness, the health equity concept developed by Amartya Sen and ethical principles mentioned by Nikola Biller-Andorno and Roberto Andorno. It is suggested that the interaction between the equity concept and a set of ethical principles (equal opportunity, efficient distribution and compassion) need to be considered in the selection of transparent and consistent criteria for organ allocation.