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.