Ethics of allocation of donor organs

Abstract

Purpose of reviewThere is no widely accepted single ethical principle for the fair allocation of scarce donor organs for transplantation. Although most allocation systems use combinations of allocation principles, there is a particular tension between ‘prioritizing the worst-off’ and ‘maximizing total benefits’. It is often suggested that empirical research on public preferences should help solve the dilemma between equity and efficiency in allocation policy-making.Recent findingsThis review shows that the evidence on public preferences for allocation principles is limited, and that the normative role of public preferences in donor organ allocation policy making is unclear. The review seeks to clarify the ethical dilemma to the transplant community, and draws attention to recent attempts at balancing and rank-ordering of allocation principles.SummaryThis review suggests that policy makers should make explicit the relative weights attributed to equity and efficiency considerations in allocation policies, and monitor the effects of policy changes on important ethics outcomes, including equitable access among patient groups. Also, it draws attention to wider justice issues associated not with the distribution of donor organs among patients on waiting lists, but with barriers in referral for transplant evaluation and disparities among patient groups in access to waiting lists.

Differential in Kidney Graft Years on the Basis of Solitary Kidney, Simultaneous Liver–Kidney, and Kidney-after-Liver Transplants

“…21,22 Of note, current eligibility criteria for SLK recipients is broader than for kidney-after-liver and preemptive kidney-alone candidates including a higher eGFR of 30 ml/min per 1.73 m 2 , which is important to consider with regard to equity. 23,24 There are important additional challenges with kidney-after-liver transplants, including multiple surgeries, potential immunological complications, and lost opportunity for kidney transplantation for liver-alone patients no longer eligible because of complications. 15 Also noteworthy in the study findings was that as compared with SLK transplants, kidney-after-liver recipients had lower DGF rates and similar length of stay as kidney-alone recipients.…”

The history of ethical principles in liver transplant organ allocation in the united states: how historical and proposed allocations system fare in balancing utility vs. urgency and justice vs. pragmatism

“…Although these goals sometimes overlap, in liver transplantation treating the patient most likely to die may not optimize postop patient survival and quality of life [15]. Bunnik's review discusses that this conflict is both unresolved and we have little understanding of public opinion on this matter [12 ▪ ]. Different organ allocation systems have addressed this conflict differently [13].…”

Uterine Transplantation and Fertility Preservation: A Hopeful Horizon for Cancer Survivors

“…Ethical frameworks must guide resource allocation, prioritizing fairness, justice, and optimal resource use. Scrutiny is crucial to prevent undue burden on donors while maximizing recipient benefits [ 46 ].…”