When faced with a transplant decision between an elderly patient with good prognosis and a 20-year-old who is a drug addict, which principle best guides the choice?

When faced with a transplant decision between an elderly patient with good prognosis and a 20-year-old who is a drug addict, which principle best guides the choice?

• A. Allocate to the elderly patient.
• B. Allocate randomly.
• C. Choose based on prognosis and potential longevity of the graft.
• D. Give it to the patient who is more vocal about their wish to receive it.

Answer: (C)

Focusing on maximizing benefit from a scarce resource guides transplant decisions. When an organ is limited, the best outcome comes from considering who is most likely to achieve longer, healthier graft function and overall survival. That means evaluating each candidate’s prognosis after the transplant and how long the graft is expected to last for them, given their medical condition and how well they can adhere to post‑transplant care. If the elderly patient has a good prognosis and the younger patient’s situation (including potential adherence challenges) reduces expected graft longevity, the option that yields the greater expected benefit is favored. Allocating strictly by age would ignore likely outcomes and waste resources. Allocation based on who speaks up more ignores medical prognosis entirely. In practice, eligibility also considers factors like adherence and support, but the core idea is to use medical criteria to predict how long the graft will function and how much overall benefit the organ will produce.

Focusing on maximizing benefit from a scarce resource guides transplant decisions. When an organ is limited, the best outcome comes from considering who is most likely to achieve longer, healthier graft function and overall survival. That means evaluating each candidate’s prognosis after the transplant and how long the graft is expected to last for them, given their medical condition and how well they can adhere to post‑transplant care. If the elderly patient has a good prognosis and the younger patient’s situation (including potential adherence challenges) reduces expected graft longevity, the option that yields the greater expected benefit is favored.

Allocating strictly by age would ignore likely outcomes and waste resources. Allocation based on who speaks up more ignores medical prognosis entirely. In practice, eligibility also considers factors like adherence and support, but the core idea is to use medical criteria to predict how long the graft will function and how much overall benefit the organ will produce.