Utilitarianism in Medicine: Organ Allocation Example Using QALYs

Utilitarian ethics — maximizing overall well-being — provides a framework for allocating scarce life-saving resources.

Scenario: Single Donor Heart, Multiple Candidates

Four patients await heart transplant. All will die without it. Only one organ available.

Utilitarian Decision Process

1. Define Utility Metric: Quality-Adjusted Life Years (QALYs) gained = (Life Years Gained) × (Health-Related Quality of Life Weight, 0–1).
2. Estimate for Each Candidate:

   Patient	Age	Condition	Post-Tx Survival (Yrs)	QoL Weight	QALYs Gained
   A	25	Cardiomyopathy	25	0.85	21.3
   B	55	Ischemic CM	12	0.80	9.6
   C	40	Congenital HD	18	0.75	13.5
   D	65	Amyloidosis	6	0.70	4.2

3. Maximize Total QALYs: Allocate to Patient A (21.3 QALYs) — greatest net benefit to society.
4. Incorporate Equity Adjustments (Optional): Prioritarian weighting (extra value for worse-off), age-weighting, "fair innings" — modifies pure utilitarian calculus.

Real-World Allocation (UNOS/OPTN)

Current US system uses medical urgency (Status 1–6), geographic proximity, blood type/size match, waitlist time — not pure QALY maximization. Ethical frameworks blend utility, justice, and respect for persons.

Critiques of Utilitarian Allocation

• Discriminates against elderly, disabled, comorbid patients.
• QoL weights are subjective and culturally biased.
• Ignores "rule of rescue" intuition (save identifiable life now).
• Difficult to predict individual outcomes accurately.

Utilitarianism offers a transparent, quantitative structure but requires tempering with equity safeguards in practice.