Ethical issues in transplant matching

Abstract

This contribution examines the ethical issues that arise when organ-patient matching is performed using algorithmic matching. The first part reviews the ethical problems present in many phases of the transplant process: who can be considered a potential donor? Who is accepted on the transplant waiting list, and ultimately, to whom does the harvested organ go? The second part presents algorithmic matching as a specific form of coordination. The third part considers the actual rules implemented in France and the United States, highlighting the different ways in which fairness in access to care—the crucial criterion for ethical evaluation—is managed. The focus then shifts to the role of matching algorithms and the changes they undergo to meet the expectations of different stakeholders. The fourth part highlights the constraint of accountability which is added to the constraints of fairness and legitimacy, particularly in the context of the first attempts to use artificial intelligence.