Summary: Americans are more likely to judge organ transplant eligibility by the cause of a person’s illness than by that person’s race or ethnicity. In a large national survey, respondents consistently favored candidates whose conditions were perceived as less self-inflicted—such as black lung disease from coal mining or genetic kidney failure—over candidates suffering from alcohol use disorder or complications from unvaccinated COVID-19.
The results underscore continuing stigma around mental health and addiction, despite growing recognition of these as medical conditions. Importantly, race and ethnicity had little to no measurable influence on public judgments about who “deserves” a transplant.
Key Facts:
- Judgment by cause: Respondents prioritized transplant candidates whose organ failure resulted from occupational hazards or genetic conditions over those whose conditions were linked to behavior.
- Stigma persists: People with alcohol use disorder were consistently ranked lowest in perceived transplant deservingness.
- No racial bias found: Race and ethnicity did not significantly alter public attitudes about transplant eligibility in this study.
Source: Texas A&M
Becoming an organ donor is easier than ever. You can register online when renewing a driver’s license or, if you use an iPhone, through an app.
Yet the need far exceeds the supply. Every eight minutes someone in the United States is added to the transplant waiting list, and about 17 people die each day while waiting for an organ.
“Given the staggering need, we wanted to know whether Americans consider some recipients more deserving than others based on the reason behind their need for a transplant and whether a recipient’s race or ethnicity affects those views,” said Simon F. Haeder, PhD, a health policy analyst at the Texas A&M University School of Public Health and a co-author of the study published in Social Science Quarterly.
Haeder noted that previous research on public attitudes toward transplant deservingness is limited in scope and often focuses on a narrow set of organs or behaviors. This study expands that scope by including organ failure linked to workplace injury (for example, coal dust exposure leading to black lung disease) and mental health factors such as alcohol use disorder.
The researchers surveyed 4,177 adult U.S. citizens between March 18 and April 18, 2022. Participants read four vignettes describing people with distinct life circumstances and names that signaled race or ethnicity.
The vignettes described: a person whose kidneys were destroyed by a genetic condition (requiring a kidney transplant); a coal miner who developed black lung disease (needing a lung transplant); an unvaccinated person severely ill with COVID-19 (needing a lung transplant); and a person with alcohol use disorder (needing a liver transplant).
To assess whether race or ethnicity influenced responses, the study used names pre-tested to signal racial or ethnic identity: Ronny Nielsen (white), DeShawn Washington (Black), Luis Hernandez (Hispanic) and Yang Chen (Asian).
After reading the vignettes, respondents rated each candidate’s eligibility for a transplant using a five-point Likert scale from “definitely yes” to “definitely not.” The survey also collected information on respondents’ political ideology (liberal or conservative) and levels of racial resentment.
Analysis comparing predicted means showed that people’s opinions are shaped primarily by the circumstances that led to organ failure, not by the candidate’s race or ethnicity. “Respondents were generally most supportive of the individual dealing with black lung disease, followed by the person with genetic kidney disease, then the unvaccinated COVID-19 patient, and lastly the individual with alcohol use disorder,” Haeder said.
The study found a clear public ranking of candidates based on perceived personal responsibility: occupational or genetic causes ranked higher than outcomes tied to behavior. The strongest support was for those with black lung disease, who often outscored all other scenarios. Genetic kidney disease typically outranked both the COVID-19 and alcohol-use scenarios.
Political ideology and racial attitudes produced some nuance. Liberals and respondents low in racial resentment showed little difference in how they rated the candidate with alcohol use disorder versus the unvaccinated COVID-19 patient. Conservatives and respondents with higher racial resentment demonstrated clearer distinctions between those two cases.
“One notable finding concerns alcohol use disorder: even though it is medically recognized as a disease, individuals with this condition were consistently judged least deserving of a transplant, revealing a persistent stigma,” Haeder said.
The lack of a clear racial or ethnic effect was also striking. Where any differences emerged, they slightly favored racial and ethnic minority candidates rather than disadvantaging them.
Haeder posed a broader ethical question: should public opinion play a role in transplant allocation? Aligning rules with public values might encourage more donors, but because organs are so scarce, allocation policies must remain careful, equitable and evidence-based.
The study’s authors suggest that these results could inform efforts to increase organ donation or to design innovations that address the organ shortage while protecting fair allocation processes.
About this psychology and organ transplantation research news
Author: Lesley Henton
Source: Texas A&M
Contact: Lesley Henton – Texas A&M
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Who’s to Blame? How Recipient Deservingness Influences Attitudes About Access to the Organ Transplants” by Simon F. Haeder et al. Social Science Quarterly
Abstract
Who’s to Blame? How Recipient Deservingness Influences Attitudes About Access to the Organ Transplants
Objective
The United States faces a severe shortage of transplantable organs. This study asks whether Americans differentiate who should receive a transplant based on whether their condition is attributable to internal (behavioral) or external (occupational, genetic) factors, and whether race or ethnicity alters those judgments.
Methods
Between March 18 and April 18, 2022, we surveyed 4,177 U.S. adults using a vignette-based experiment. Each respondent evaluated four hypothetical patients with distinct causes of organ failure and names that signaled racial or ethnic identity. We used comparisons of predicted means to measure differences in responses.
Results
Public attitudes were influenced by the life circumstances that led to organ failure, with occupational and genetic causes viewed more sympathetically than behavior-linked causes. We found little systematic differentiation based on the race or ethnicity signaled in the vignettes.
Conclusion
Further research should evaluate whether and how public attitudes ought to inform transplant allocation policies, balancing the potential to increase donor support against the need for fair and medically grounded allocation systems.