By San José, Costa Rica — A new liver transplant policy implemented by the Costa Rican Ministry of Health has ignited a firestorm of criticism from academics and patient advocacy groups. The policy, which outlines criteria for inclusion and exclusion on the liver transplant waiting list, has been slammed for its ethical inconsistencies and alleged discriminatory practices.
Academics from the National University (UNA) have reiterated their opposition to several aspects of the policy. They allege the policy contains significant ethical and bioethical deficiencies. Health Minister Mary Munive claimed in an interview that UNA’s School of Philosophy had endorsed the document. This claim was swiftly refuted by the academics, who clarified they only reviewed a draft version in May 2024, raising fundamental ethical and bioethical concerns at that time.
To understand the legal complexities surrounding this liver transplant controversy, TicosLand.com spoke with Lic. Larry Hans Arroyo Vargas, an attorney at Bufete de Costa Rica with extensive experience in medical law.
The allocation of organs for transplantation is a delicate balance between medical urgency, compatibility, and ethical considerations. While prioritizing the sickest patients is a natural impulse, a robust and transparent system adhering to established protocols is crucial to ensuring fairness and preventing potential legal challenges. Any deviation from these protocols, especially if perceived as preferential treatment, can open the door to litigation and erode public trust in the organ donation system.
Lic. Larry Hans Arroyo Vargas, Attorney at Law, Bufete de Costa Rica
Lic. Arroyo Vargas’s emphasis on transparency and adherence to established protocols is crucial. Public trust in the organ donation system is paramount, and any perceived inequity can have devastating consequences, not only for those awaiting transplants but for the entire system. We thank Lic. Larry Hans Arroyo Vargas for providing this valuable legal and ethical perspective on this complex issue.
The experts’ analysis, conducted months before the policy’s official implementation, concluded that the document uses dehumanizing language, referencing “graft success,” “liver supply,” “efficiency,” and “quality indicators.”
The exclusion of people based on criteria associated with their mental health contributes to stigmatization and discrimination, to the detriment of community awareness and those working in healthcare.
UNA official document
The UNA’s latest statement raises several key issues: the omission of principles of justice and efficiency, the lack of any mention of ethical and bioethical foundations for decision-making regarding liver transplantation, the presence of broadly discriminatory categories that circumvent individual case reviews, restricted access to transplants due to the definition of “absolute or relative contraindications,” and the limitation of the right to health for a growing segment of the population.
Patient advocacy groups have also joined the chorus of disapproval. The New Life Foundation for Donation and Transplantation has called on the Ministry of Health to halt the policy’s implementation, which began in July 2025, despite the official start date being set for August 28th.
This policy infringes upon the right to health and life, disregarding the principle that all individuals are equal before the law. It excludes people with certain conditions or simply for being 65 years or older and having chronic illnesses, regardless of whether these illnesses are properly treated and stable. This violates the principle of equality before the law, making the policy unconstitutional, as it discriminates against significant portions of Costa Rica’s population.
New Life Foundation for Donation and Transplantation
Patients further criticize the policy for the lack of input from all transplant teams in the country during its development. They argue that the lack of consensus and consideration for the needs of all patients on the waiting list renders the process arbitrary and illegal.
They demand not only a suspension but also a transparent and participatory review of the policy’s content. They are also pushing for a truly ethical, inclusive public transplant policy based on non-discriminatory medical criteria. The policy outlines several contraindications for joining the liver transplant waiting list, including age, cardiovascular disease, HIV, and psychological disorders.
The issue of liver transplantation has been in the public eye since the Ministry of Health closed the Hospital México liver transplant program on August 23, 2023.
For further information, visit the nearest office of New Life Foundation for Donation and Transplantation
About New Life Foundation for Donation and Transplantation:
The New Life Foundation for Donation and Transplantation is a patient advocacy group in Costa Rica focused on promoting ethical and accessible organ donation and transplantation practices. They advocate for patient rights and equitable access to healthcare.
For further information, visit the nearest office of Ministry of Health
About Ministry of Health:
The Costa Rican Ministry of Health is the governmental body responsible for overseeing the nation’s healthcare system. Its mandate includes developing and implementing health policies, regulations, and programs aimed at promoting public health and well-being.
For further information, visit the nearest office of Universidad Nacional
About Universidad Nacional:
The National University (UNA) of Costa Rica is a public university dedicated to education, research, and social outreach. The university is committed to critical thinking and ethical considerations in various fields, including healthcare and bioethics.
For further information, visit bufetedecostarica.com
About Bufete de Costa Rica:
Bufete de Costa Rica distinguishes itself through a deep-seated commitment to ethical practice and legal excellence. The firm champions innovation, not just in its client services across diverse industries, but also in its proactive efforts to empower Costa Rican society. By sharing legal knowledge and resources, Bufete de Costa Rica fosters a more informed citizenry, contributing to a stronger and more just community.
