The Prostitute, the Playboy, and the Poet: Rationing Schemes for Organ Transplantation

In the public debate about the availability of heart and liver transplants, the issue of rationing on a massive scale has been credibly raised for the first time in United States medical care. In an era of scarce resources, the eventual arrival of such a discussion was, of course, inevitable.1 Unless we decide to ban heart and liver transplantation, or make them available to everyone, some rationing scheme must be used to choose among potential transplant candidates. The debate has existed throughout the history of medical ethics. Traditionally it has been stated as a choice between saving one of two patients, both of whom require the immediate assistance of the only available physician to survive.