Transforming objectivity to promote equity in transplant candidate selection

Abstract

It is necessary to recognize the variety of levels at which values and norms may inappropriately affect the equity of the transplantation process, including candidate selection. Using a revised, richer concept of objectivity, adopted from Longino's work in the philosophy of science and empirical studies of candidate selection, this paper examines what sort of objectivity can be obtained in the transplant candidate selection process, and the closely related question of how selection can occur in an equitable manner. This concept of objectivity requires that transformative criticism occur so that (1) the conceptual and normative commitments underlying selection may be articulated and perhaps challenged, and (2) the relationship between those commitments and criteria for candidate selection may be examined and justified, or revised. Through such transformative criticism, a greater degree of objectivity may be attained, which in turn will increase the likelihood of equity.