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April 20, 1994

Retransplantation of Scarce Organs: The Ethical Lessons-Reply

Author Affiliations

University of Pittsburgh Pittsburgh, Pa
University of Minnesota Minneapolis

JAMA. 1994;271(15):1157-1158. doi:10.1001/jama.1994.03510390027014

In Reply.  —We agree with Dr Zinberg that many rational planners would favor allocation schemes that favor primary transplant candidates over retransplant candidates. However, as we pointed out in our article, theories guided by what a rational planner would choose are inadequate to decide transplant allocation because philosophers do not agree on what a rational planner would choose. A number of scholars argue that a rational planner ought to choose a utilitarian system of justice.1,2 Zinberg contends that a rational planner would give primary candidates priority whether or not this increased utility. Rawls would probably not agree with either view. Rawls is careful to point out that his theory of justice is an alternative to utilitarianism.3 He also takes great pains to argue that his rational planner would place high priority on raising the level of the worst off in society. For transplantation, that could mean giving priority

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