Wow…. tough question. No-one should be able to manipulate the system like you suggested. In my mind every life should have an equal chance. On the other hand… economics always play a part. To even make it to the list you have to be in a privileged position. (You need to be able pay for the procedures / be appropriately insured and have access to the health care system overall, ie live in the right country.) Unfairness is always there, but that should not stop the donor system from trying to help as many qualifying people in the fairest way possible, without looking at the depth of their pockets. Now, if my children would need an organ to save their live, I personally would be very tempted to tweak the system and anything I can to get them the help they need. It would be up to the system then to remain honest.