Who Should Get Priority for Transplants?

Q. Do you think that younger people should get priority over older people to receive organ transplants?

SEE ALSO: The Money and Ethics Quiz

A. In general, yes. That doesn't mean that Americans in their sixties and seventies shouldn't be permitted to get a transplant, but preference should be given to prospective recipients who are likely to get a greater benefit (that is, more years of productive life) from the operation -- say, favoring a 35-year-old over a 70-year-old.

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Transplant organs are a scarce resource for which the limited supply has to be allocated in some way. Buying an organ is illegal in the U.S. and the vast majority of nations. A truly random lottery among medically suitable recipients could be used, but it isn't.

Instead, the U.S. uses a first-come, first-served system, in which eligible recipients of all ages -- screened for their likelihood to survive the operation and thrive -- are put on a waiting list in their home regions (and sometimes more than one region). The next available organ goes to the closest, sickest patient who is the best medical match for the organ.

The only age preference is for recipients under 18, who accounted for 16% of heart transplants in 2011. Over 18, there is no prioritizing by age, just by whether an available organ is a good match for the next recipient in line. A middle-aged heart that wouldn't be a good fit for a child might be given instead to an elderly patient who is further down the waiting list. Recipients 65 and over accounted for an estimated 12% of all U.S. heart transplants in 2008, with Medicare covering costs that can approach $1 million per procedure and recovery.

The more variables we introduce -- including but not limited to age -- the stickier the ethics get. Some argue for "social worth" and "merit/demerit" screens, under which, say, a mother of three young kids would get priority over a single person, a 60-year-old research scientist would get priority over a 20-year-old high school dropout, and a person who damaged his or her liver with heavy drinking would be ineligible for a new one. I think such criteria would be too subjective to be workable, but a general preference for young over old does make sense for society, ethically and economically.

Research for this column was done by editorial intern Ted Leonhardt from Duke University.

This article first appeared in Kiplinger's Personal Finance magazine. For more help with your personal finances and investments, please subscribe to the magazine. It might be the best investment you ever make.