To the Editor.
—I agree with Dr Ubel and colleagues1 that transplant efficacy justifies revising the organ allocation system to direct more organs to primary transplant candidates instead of retransplant candidates. Unlike the authors, I believe Rawls' theory of justice2 supports this course. Rawls proposes that people behind a "veil of ignorance" that obscures their current or future conditions will choose a just allocation of social goods. Rational, self-interested persons would want to maximize their chance of receiving a scarce, lifesaving resource (such as an organ transplant) should the need arise. They may be ignorant as to whether they will ever need a transplant, but it is common knowledge that transplantable organs are in short supply. Limiting the number of scarce organs any one person can receive would, as Ubel et al agree, maximize everyone's opportunity to receive a transplant. Rational planners would be willing to forgo potential retransplantation
Zinberg JM. Retransplantation of Scarce Organs: The Ethical Lessons. JAMA. 1994;271(15):1157. doi:10.1001/jama.1994.03510390027012