Nataline Sarkisyan died last month after her health insurance company refused to pay for a liver transplant but then changed its decision after a lot of negative publicity.
According to a story in the Philadelphia Inquirer, "Nataline Sarkisyan's case raises complex questions about how we ration resources - money and, in this case, transplantable livers - and how we make medical decisions in what one ethicist called 'last-chance' situations."
There aren't enough livers available to give one to every person who needs a liver transplant. Deciding to give a liver to one person means someone else won't get one. These are undoubtedly difficult decisions to make.
Deciding whether or not to donate your organs when you die seems very simple in comparision. But only about 50% of adult Americans have registered as organ donors. About half of the livers that could be donated are buried or cremated instead. The people who blow the easy decision about donating force the difficult decisions about rationing.
Under the organ allocation rules used by the United Network for Organ Sharing, people who won't donate pay no price for their decision. They remain eligible to receive a transplant if they ever need one. It's no wonder there is such a large shortage of livers.