Epistemic Authority and Trust in Shared Decision Making About Organ Transplantation

AMA J Ethics. 2020 May 1;22(5):E408-415. doi: 10.1001/amajethics.2020.408.


Patient epistemic authority acknowledges respect for a patient's knowledge claims, an important manifestation of patient autonomy that facilitates shared decision making in medicine. Given the scarcity of deceased donor organs, transplantation programs state that patient promises of compliance cannot be taken at face value and exclude candidates deemed untrustworthy. This article argues that transplant programs frequently lack the data to make this utilitarian calculation accurately, with the result that, in practice, the psychosocial evaluation of potential transplant candidates is discriminatory and unfair. Historically excluded candidates, such as patients suffering from alcohol use, have turned out to benefit highly from transplantation. Transplant programs should tend to trust patients when they claim to be good potential organ stewards, thereby respecting patient autonomy, advancing justice, and saving more lives.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Decision Making
  • Decision Making, Shared
  • Humans
  • Organ Transplantation*
  • Patient Compliance
  • Social Justice
  • Tissue and Organ Procurement*
  • Trust