Directed altruistic living donation: what is wrong with the beauty contest?

This paper explores the specific criticism of directed altruistic living organ donation that it creates a ‘beauty contest’ between potential recipients of organs. The notion of the beauty contest in transplantation was recently used by Neidich et al who stated that ‘[a]ltruism should be the guiding motivation for all donations, and when it [is], there is no place for a beauty contest’. I examine this beauty contest objection from two perspectives. First, I argue that, when considered against the behaviour of donors, this objection cannot be consistently raised without also objecting to other common aspects of organ donation. I then explore the beauty contest objection from the perspective of recipients, and argue that if the beauty contest is objectionable, it is because of a tension between recipient behaviour and the altruism that supposedly underpins the donation system. I conclude by briefly questioning the importance of this tension in light of the organ shortage.