Alcoholic cirrhosis is self-inflicted, but many people with hepatitis C cirrhosis requiring transplantation acquired the virus through blood transfusions pre-1990s or else the etiology is unknown. Of course, there are plenty who became infected through IV drug use, but I think it would be too difficult to transplant those who became infected through transfusions vs those who became infected through IV drug use. “I’ll transplant you because you say that you had a bad transfusion, but I won’t transplant you because you were honest about your drug habit.”

A lot of the kidney transplant patients for whom I have cared were type 1 (“juvenile”) diabetics in renal failure or had a condition called focal segmental glomerulosclerosis (a disease not caused by one’s actions). However, I did see patients getting their second and third kidney transplants because they had not been compliant with their medications following the first transplant. I’m of the opinion that, with an organ shortage, the least one can do is care for the organ they were fortunate enough to obtain.

However – with all of these disclaimers out of the way, OF COURSE I agree with you that we need better incentives for people to care for themselves. After all, better diet and fitness would result in less type 2 diabetes, which would result in less renal failure, which would reduce the need for transplantable kidneys. If people weren’t alcoholics, then that would very much reduce the need for transplantable livers. Besides, given a huge national deficit and healthcare costs spiraling out of control, doesn’t it just make more sense to encourage health, from an economic perspective?

This also leads me to think that self-inflicted recipients should be lower priority regardless of need…but maybe I’m just heartless.