Fig. 4

Trust relationships from the recipient’s perspective. From the potential recipients viewpoint, the objects of trust can be grouped alongside various ethical considerations, from ensuring that donor ODT and allocation are organised in an efficient manner to maximise the advantages obtained from the scarce resource of donor organs. Potential recipients also need their doctors and the members of the health care team to assist them in making the right decisions concerning the acceptance of certain types of organs (e.g. living or deceased donor organs, marginal grafts, HLA and blood group matching, domino transplantation, split liver grafts) and the timing of the transplantation. The trust in the health care teams also extends to the period during and after transplantation, as organ transplantation is a major surgical intervention, whose prospects of success depend on the experience of the surgical teams and recipients will need lifelong immunosuppressive therapy and support in maintaining the best possible organ function. Finally, in the case of recipients, it is important that the law does not base a system of organ procurement based on economic cost so that the organs can be purchased at a reasonable cost as this would lead to inequality between people from different social groups. Besides, in registering for a transplantation program, potential recipients generally need to trust that they have at least a slim chance of getting a suitable donor organ and that the surgical intervention will improve their health and/or life expectancy. For the majority of potential recipients, this entails the belief that donor organs are allocated fairly, i.e. that the allocation system satisfies basic principles of distributive justice such as equality, effectiveness, or medical urgency, although people seem to differ on their personal view of what a fair distribution of donor organs should look like [30, 31]