Imagine two patients in need of a heart transplant. One is a young athlete with a congenital heart defect. The other is an older man with heart failure due to a lifetime of unhealthy choices.
Who should get the transplant?
It seems like a question for doctors, donors, family members and even spiritual advisors. But Seyeon Moon, a philosophy major and recipient of the Columbian College of Arts & Sciences’ Luther Rice Undergraduate Research Fellowship, argues there’s another important voice with insights on the life-and-death debate: philosophers.
Her Luther Rice research project on the ethics of organ donation tackles the profound moral quandaries surrounding the nation’s complicated organ transplant system. With more than 100,000 people in the United States needing organ transplants—and as many as 22 a day dying as they wait—Moon is consulting medical guidelines, transplant surgeons and bioethicists to untangle the critical questions looming over how we allocate scarce organs.
Should children move to the head of the line? What do we owe to prior living donors? Should we deprioritize people based on behavior—like alcoholism, chronic smoking or even incarcerated individuals—in favor of those who society deems more deserving?
“The moral questions surrounding medical decisions are among the most complex and nuanced,” Moon said. “Philosophers and ethicists know how to ask the right questions.”
For nearly 40 years, the organ donation system in the United States has been run by the national nonprofit United Network for Organ Sharing (UNOS). Under contract with the federal government, the network maintains the transplant waiting list while coordinating with hospitals and organ procurement organizations to match candidates with donated organs.
Currently, that system is very much in flux. Congress has conducted hearings on alleged UNOS shortfalls and mismanagement. Plans are in place to overhaul the system to include multiple contractors and improve accountability and transparency.
Even as transplant guidelines are being restructured, the waiting list criteria still lean on compatibility and viability—factors including medical urgency, blood type, body measurements and how quickly more perishable organs like hearts and lungs must be transplanted.
And while an UNOS ethics committee plays a role in drafting guidelines, Moon said it remains unclear exactly how complex moral questions are resolved. Her Luther Rice research isn’t intended to re-write the transplant guidelines, she said, but to highlight the system’s ethical tightrope—and balance the factors that influence critical decisions.
“Ethics lies at the core of everything we do and in determining what we ought to do,” she said. “Given that healthcare touches millions of lives every day, it feels imperative that we strive to make the right and just choices in every decision we face.”
Philosophy's Real-World Impact
Moon didn’t plan to major in philosophy at GW. Her interests ran toward public health and medicine, and even today she hopes to pursue a career in law. But after taking a bioethics course with Elton Professor of Philosophy David DeGrazia, she was introduced to the impact philosophy can have on public policy concerns from AI in healthcare to debates over euthanasia to advancing animal welfare.
“I didn’t find that human aspect [in science]. It didn’t answer my questions,” said Moon, who is also a GW National Churchill Fellow. “Philosophy clicked for me. It teaches me a lot about critical thinking.”
Indeed, Associate Professor of Philosophy Laura Papish, Moon’s Luther Rice faculty adviser, noted that philosophy research can be as scientifically rigorous as other disciplines. The faculty at the CCAS Philosophy Department, she stressed, cover a gamut of theoretical and empirical expertise.
“We have people who work on more theoretical questions like the nature of consciousness. I do a lot of historical work. And we have faculty who are very much interested in how philosophical thinking can be brought to bear on practical questions,” she said. “Our students often have empirical or practical concerns and they’re interested in how philosophy can be used to help clarify or resolve them.”
For her Luther Rice project, Moon formulated arguments based on real-life data and brought scientific reasoning to questions about transplant utility, justice and autonomy—UNOS’ three guiding principles. In addition to scouring policy and statistics, Moon consulted with a transplant hospital in her native Hawaii and bioethicists in D.C. And each conversation raised more ethical dilemmas.
Do patients’ physical location, for example, impact prioritization because they can quickly reach a hospital when racing the clock for a perishable organ? Or, Moon asks, does it penalize people whose limited financial means block access to numerous transplant facilities?
“These are murky waters,” she said. “As ethicists, we want to demand and propose the perfect, ideal solution. But as bioethicists, we need to deliver results, which means that our proposals have to be realistic.”
Moon’s project is “challenging because it straddles the theoretical and the practical,” Papish said. “It requires her to master various philosophical points of view about the nature of harm and benefit. But then she has to consider these hard, more empirical questions about how public opinion should factor in and which allocation criteria can be practically implemented. It’s a very complicated, interdisciplinary project.”
Moon hopes to publish her Luther Rice research in a peer-reviewed journal and present it at conferences including the CCAS Research Showcase. At some point, she said, she’d like to show her findings to the UNOS ethics committee.
“This is an emotional topic, and these are incredibly hard questions, which are very consequential to individuals and to community members,” she said. “I’m empathetic to the people who have to make these life-changing decisions. As a philosophy researcher, I’m passionate about ensuring fairness and equitable access for all.”