The Organ Transplant Problem

In “The Survival Lottery,” John Harris puts forth the following scenario:

Suppose that organ transplant procedures have been perfected; that is to say the only obstacle between a sick patient being saved and a doctor saving them is the availability of the proper organs. Therefore, if the doctors are in possession of the necessary organs required to save two dying patients, then we can hold these doctors responsible for the lives of the patients. This means that if the doctors allow the patients to die, we can say they died because their doctors refused to treat them. However, if the doctors don’t possess the necessary organs to save the two patients, then we would not be inclined to say the doctors caused the patients’ deaths.

Further supposed that these two patients, A and B, are quite unhappy about being left to die. A requires a new heart and B needs a new pair of lungs, so they propose that if organs were harvested only from one healthy person, D,  then two lives could be saved. The doctors quickly jump to the obvious objection that it would be worse to kill one person than to allow two to die. They would like to hold that we have an obligation not to kill, but only a lesser duty of sorts to save life. A and B are not satisfied with this response. While agreeing that an innocent life should never be taken, they do not see how they are any less innocent than D; not one of the three has done anything deserving of death. From here, A and B argue that if a doctor refusing to treat a patient results in the patients’ death, then “he has killed that patient as sure as shooting.” In this sense, A and B wish to equate their own deaths with the forced death of D. If their premises hold true, then I would be obliged to agree with them. A and B seem to think they’ve done a splendid job thus far and move on to further objections and their proposal of a Survival Lottery. I, however, do not think their argument thus far holds up.

First, if A and B needs organs urgent enough to consider the killing of another person to save themselves, then surely one of them will be dead soon, the organs from whom can be used to save the other. A and B would argue that this creates a special group out of the sick, saying that we somehow discriminate against them by only selecting donors from the sick. I, on the other hand, think of it as a group of those that supports the notion that it is ok to kill in order to preserve life. This form of their proposal lies rather close to suicide, which I find much easier to justify than killing. A and B could also object by saying that we are only saving one life in this manner instead of the under their proposal. This would be rather sloppy of them, however, as it forgets about D, who will be left alive.

There is also a problem with how A and B play with the notion and treatment of innocents. They propose two premises in tandem that really only work separately: that killing an innocent is universally wrong, and that if a doctoring refusing to treat an innocent patient results in the patient’s death, then the doctor killed the patient. The second premise can only come about if the first premise isn’t present. If there truly were no other organs, not even from other people, surely A and B would not blame death on the doctor. So in the presence of other people, where are these organs supposed to come from if killing innocent people is always wrong? A and B’s objections to killing innocent civilians (those not in need of transplants) revolve around accusing those making objections of avoiding the question. This is hardly fair as it neglects the fact that there’s something wrong with their primary premises.

Perhaps, then, we should investigate their argument as if they had not insisted that killing innocents is always wrong? This unfortunately leaves without any solid motivation for treating A and B at all, with or without the organs. Sure sometimes the doctors will use D’s organs to save A and B, but other times they won’t. Something tells me A and B wouldn’t quite be satisfied with this.

Harris, John. "The Survival Lottery." Pub. in Reason and Responsibility: Readings in Some Basic Problems of Philosophy. 637-641.