Development in medical practices and related fields has led to major advances in the field of organ donation and transplantation. This is quite apparent in the case of liver transplants since thousands of patients across the globe now undergo successful liver transplants throughout the year. A liver transplant is an essential procedure carried out for people who are diagnosed with long-term liver disease which may often lead to liver failure.

Liver cirrhosis is one of the most common diseases that requires a liver transplant. Other conditions that can be cured by a liver transplant are bile duct diseases, chronic hepatitis B and C, autoimmune liver diseases, genetic diseases, alcoholic liver diseases, primary liver cancer, and fatty liver disease.

While the survival rate has improved remarkably when it comes to liver transplant procedures, there has been a rise regarding several ethical issues concerning organ donation and transplant. Three of the most common ethical issues include – issues of procurement, issues of allocation, and issues of affordability. These issues further complicate when you scrape the surface. This is because each ethical challenge is inter-related. One cannot take a standalone approach and each of the issues must be addressed concerning the other.

Procurement Issues

Like most things in our life, the demand for cadaver or live-donor organs also exceeds the demand. Thus, whenever a liver transplant is required, one must deal with the challenges regarding the procurement of the organ. This is extremely important since the number of donors available is a lot less than required.

The process of organ donation is comparatively ineffective because of several reasons. Organs are lost when clinicians are unable to identify the criteria for brain death. Educational programs for health care providers could help illustrate laws regarding the declaration of brain death. Also, requests for organ donation are often handled by inexperienced workers which are associated with a reduced consent rate.

Thus, it can be seen that the procurement of an organ is quite difficult. And the complex system further complicates the process. While donors have the right to withhold consent, the ones who express consent are not always obtained due to procedural reasons.

Allocation Issues

As far as allocation is concerned, there is not a fool-proof mechanism always that will ensure a fair chance of survival for everyone, every time. The problems of governing ‘necessity,’ ‘emergency,’ and ‘immediacy’ are often clouded by various subjective factors. The receiver of a transplant should ideally get a greater benefit as compared to others. However, arriving at a conclusion is easier said than done.

Two major competing values are considered in all organ allocation decisions. They are justice and utility. There is a classic dilemma that is faced in the allocation of organs. This is because any system designed to allocate organs efficiently is expected to be unjust or unfair. A supporter of maximizing utility would focus on doing the maximum with a limited resource. While on the other hand, an advocate of justice would want fair distribution. According to them, justice means providing benefit to the one who needs it the most. Physicians usually prefer utility while the government aims to make a fair decision.

Affordability Issues

After the procurement and allocation of the organ to the right recipient, the question of affordability arises. Organ transplantation can be expensive. Thus, the upper class of the society can afford them, the relatively weaker sections are unable to get this procedure done. The government must take certain steps to come up with a solution to this ethical dilemma. But this may also raise issues for people who can afford a transplant procedure and are still denied permission. Thus, there is still no fixed formula or methodology that would solve this issue.


There is no doubt that medical science has helped us find successful solutions to numerous complex medical conditions. But certain ethical challenges would need a more humane approach.

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