The Principle of Double Effect and Organ Donors with Hepatitis C.

AbstractSolid organ transplants save lives, but demand for transplantable organs outpaces supply. Traditionally, organs from patients infected with the Hepatitis C virus (HCV) were ineligible for donation to recipients without HCV (HCV D+/R- transplants) owing to concerns about intentionally transmitting HCV to organ recipients. New direct-acting antivirals against HCV and increased HCV+ organs from the opioid epidemic promised to solve the organ shortage. In 2017, the American Society of Transplantation argued that HCV D+/R- transplants are ethically permissible to maximize transplantable organs. This utilitarian argument suffers from flaws inherent to utilitarianism and could be made obsolete by resolving the organ supply/demand mismatch. A better argument for ethical HCV D+/R- transplants arises from the principle of double effect (PDE). The good effect of prolonging a life through transplantation outweighs the evil effect of infecting recipients with HCV. The PDE provides ethical grounding for HCV D+/R- transplants and creates better informed consent discussions.