Ethical Dilemnas in Directed Kidney Donations

Should a person be able to donate his or her kidney to whomever they prefer, or should all kidneys go to the next person on the waiting list?

This is a major ethical dilemma. Basically, with one possible caveat, I feel that a person should be able to direct their kidney donation to whomever they see fit. I explain my opinion fully below.

Basically, Douglas Hanto, M.D., a Harvard Medical School physician, is quoted to have said “Organs should go to the person who needs them the most, not to people because they are members of a club.” See Dr. Sally Satel's article about one example of Dr. Hanto's action to try to stop directed kidney donation
here.

Robert F. Hickey, Ph.D. is a big advocate of live donor kidney donation. Dr. Hickey's life was saved by a live donor donation and he zealously advocates for the right of people to direct their live donor organ donation. He debated Dr. Hanto on this topic recently at Harvard University.

Robert F. Hickey asked me about my reaction to a situation that was raised at the debate at Harvard. A certain Rabbi who was in attendance said that he advocates for his congregants to donate their organs [exclusively] to other Jews and (I think) to only accept organs from other Jews. Below is my response to the Rabbi's approach.

"This is what I feel about a Jew, or any other segment of the population directing their donation to their own group. While I feel that their motives may not be completely pure, I care about pragmatic results, not some theoretical morality or utopian concept of altruism. If a Rabbi encourages his congregants to donate organs only to other Jews, I feel he is doing a morally just thing anyways b/c Jews are on the waiting list like everyone else so if he encourages his congregants to give directed donations and thereby increasing the pool of organs available for transplantation, there will be a net gain in organs available for transplantation and therefore it will, in final analysis, help Jew and non-Jew alike by that Rabbi encouraging his congregants to donate their organs to Jews."
"Now, a morally troubled outgrowth from such an approach that may arise would be if there was a non-Jew on the waiting list who would certainly die today without the transplant and a Jew who can still live for a while as he awaits a transplant. I would recommend in that situation to give the organ to the non-Jew (pay the organ forward) and then give the next organ that becomes available on the waiting list to the Jewish person on the waiting list."
"Besides for these reasons, I believe that the Rabbi can legitimize his approach from a personal autonomy/libertarian perspective as well."
"Personally, though, I feel the best thing to do would be to take a different approach. I think that the Rabbi may be misguided because his approach can be interpreted with a xenophobic connotation so I think he would be better off to teach his congregants the economics lesson I shared above so that his congregants will understand that by donating organ, they will help everyone on the waiting list, which will definitionally move all of the Jews on the list closer to getting their transplants as well."

I do think, however, that people will tend to donate organs in greater numbers for people they fell a greater kinship for (like family, friends, coworkers, etc.) so from a behavioral economics perspective, there would probably be an increased number of organs available for transplantation if we encouraged more people to give directed organ donations to people they are close with socially. This would, in final analysis, cause more lives to be saved so I think the Rabbi is doing a positive thing - saving human life.