Scarcity, Systems, and The Transplant Trolley Problem

This paper offers a structural critique of the Transplant Trolley Problem by reframing it as a problem of system design rather than individual moral choice. Drawing on the classic trolley literature, the analysis argues that the ethical tension attributed to transplant surgeons arises not from their agency but from system-generated scarcity that is treated as natural and immutable. By relocating responsibility from the surgeon to the upstream structures that produce scarcity, the paper shows how trolley-style reasoning misrepresents real-world decision contexts and obscures systemic incoherence. The argument suggests that scarcity-driven “moral dilemmas” are better understood as coordination failures that can, in principle, be addressed at the level of policy, technology, and institutional design rather than through individual ethical sacrifice.