Reports of four organ transplant operations a UCLA surgeon performed on members of a Japanese crime syndicate have sparked debate among ethicists as to who should receive precious donated organs -- and whether wealthy foreigners should be allowed to "buy into" a system to which they do not contribute.
According to a Friday report in the Los Angeles Times, Ronald W. Busuttil, chief of liver and pancreas transplantation at UCLA Medical Center, provided the lifesaving operations to a powerful Japanese gang boss and three other members of a group known as the Yakuza between 2000 and 2004.
The Times report indicates that during this period organs were scarce and more than 100 people in and around Los Angeles died in each of these years as they awaited organs.
In a statement, the UCLA Health System responded that privacy laws prevent it from commenting on specific cases. Nor did the institution reveal to The Associated Press how much the Japanese paid the hospital for its transplant procedures.
Busuttil, in a statement of his own, noted that in his position as a surgeon "it is not my role to pass moral judgment on the patients who seek my care.
"If one of my patients, domestic or international, were in a situation that could be life threatening, of course I would do everything in my power to assure that they would receive proper care," he continued. "I consider that to be part of my responsibility and obligation as a physician."
And the United Network for Organ Sharing distanced itself from the cases in response to the Times article, noting that "the individual transplant center makes all decisions about evaluating and accepting transplant candidates. The [Organ Procurement and Transplantation Networks] role is organ allocation, and we are not involved in any decisions regarding an individual patient's qualification for a transplant. ... Federal law and regulation that guides the OPTN bars us from basing any allocation decisions on personal 'social worth' factors including personal history."
But some worry that the perceived inequality of the case could have a chilling effect on organ donation.
"The biggest risk here is how it might dry up the public altruism that leads to the contribution of organs to the system," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. "There is nothing more toxic to this than the belief that an undeserving foreign criminal is getting priority in American transplant centers."
Ethicists cite two facets of the case as being potentially problematic for the public when it comes to the fairness of cases such as the one at UCLA. One is the idea that criminals or those with a criminal history would be considered as worthy for a lifesaving transplant than another person who had no criminal record.
But Bill Allen, director of the program in bioethics, law, and medical professionalism at the University of Florida College of Medicine in Tallahassee, noted that as far as this aspect is concerned, the ethical balance is clear.
"The criminal law does not specify that persons convicted of crimes, much less those suspected of crimes, should lose access to lifesaving medical care as a result of their crimes," Allen said. "Social worth criteria as a material principle of resource allocation has always been full of problems, and this is just another example."