Numerous theories of justice have been proposed to help address the distribution of limited healthcare resources. Common to most of these theories are the following proposed principles of distributive justice:
- Need: According to Lo (2013), in liver and heart transplantation, priority is given to those in greatest need (ie: who would die soon without transplantation over stable patient.) This concept may appear to be useful and justifiable; however, it is a complex concept due to the fact that individuals may perceive need differently than their professional providers or health plan. In addition, geographical disparities remain (Lo, 2013, pg. 299).
- Equity: "The concept of equity sounds relevant and useful; however, it rarely serves well as an effective criterion for allocating health care resources. For example, in any health plan, organization or society, there will be a wide range of demand for services ranging from individuals who require few health care services to those who require continuous care for life. No one would advocate the provision of services to healthy individuals just to get an equal share of publicly financed health care. Likewise, U.S. norms will not support the denial of health care to an individual merely because the number of
services or cost of care has exceeded some predetermined quota" (Maddox, 1998, no page available). - Contribution: "The consideration of contribution requires a determination of what an individual might be expected to give to society at a future date. To require a contribution to society as a prerequisite to receive services is likewise considered unfair as a precondition to receiving health care and services. The mechanism of projecting or determining future contributions for prospective recipients such as infants and children, or those from poorly educated and unskilled backgrounds is not realistically feasible" (Maddox, 1998, no page available)
- Ability to pay: Transplantation is generally performed only on patients who can pay for it. Even though decision based on ability to pay are counter to the fundamental belief of equity, generosity and charitableness help by most; it is still routinely practiced.
- Patient effort: Patient's effort of practicing healthy behaviors and comply with medical advice should be consider in the decision for transplantation. Patients who fail to observe medical advice and are habitually non-compliant should be reconsidered about the effort they will make to expend to help themselves.
- Merit: "The potential to benefit from the additional investment of limited health care resources, merit is particularly valuable as a criterion upon which to base difficult or limited resource allocation decisions for individual and population-defined situations" (Maddox, 1998, no page available).
- Anticipated benefit of transplantation: This concept is controversial and unproven; however, it is proposed to better match organs with recipients who have longer estimated survival rate (ie: younger patient vs. elderly patient).