Background: Whether the twin aims of alleviating organ shortage and of increasing justice of organ allocation necessarily conflict with each other or can be simultaneously furthered while the autonomy of patients is respected is an important question in organ transplantation. It is shown that very minor reforms of existing schemes of organ allocation could increase the scope for justice, autonomy, and beneficence simultaneously.
Method: Willingness to donate discriminates between patients of comparable medical status in the elective category by preferring potential donors over nondonors. High urgency patients as well as children have priority over patients in the elective category. The proposed solidarity model can easily be implemented, for example, as a sixth ranking scale added to the existing allocation algorithm of Eurotransplant.
Results: 1. More justice and more beneficence. It is excluded that of two recipients of equal medical suitability, a patient who is unwilling to donate is unjustly preferred to one who is willing to donate, whereas enhanced solidarity with donors will increase the number of donations and, thereby, the scope for beneficence. 2. Enhanced involvement of individuals and hospitals. More people are induced to declare actively their willingness to donate which in turn enhances the moral obligation of hospitals to participate in transplantation. 3. Fair treatment of dissenting minorities, local residents, and nonresidents. The solidarity model favors altruistic contributors to the organ pool over noncontributors without discriminating against groups.
Conclusion: A solidarity rule for organ allocation should be gradually introduced.