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Updated: May 29, 2026
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Published on: March 27, 2018
Rational rationing or discrimination: balancing equity and efficiency considerations in kidney allocation.
1The Transplant Institute and Center for Transplant Outcomes and Quality Improvement at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. kladin@post.harvard.edu
Summary
The proposed kidney allocation algorithm changes aim to increase life years gained post-transplant but may raise concerns about age discrimination and live kidney donation. This study evaluates the proposal
Area of Science:
- Transplantation research
- Health resource allocation
- Bioethics
Background:
- The Organ Procurement and Transplantation Network (OPTN) proposed changes to the kidney allocation algorithm after six years of deliberation.
- The proposal has ignited debate regarding priority-setting for scarce organs and potential discrimination.
Purpose of the Study:
- To address objections to the proposed kidney allocation algorithm changes.
- To evaluate the merits, benefits, and shortcomings of the proposed algorithm.
- To assess the proposal's impact on equity and efficiency in organ allocation.
Main Methods:
- Analysis of the OPTN's concept document and associated arguments.
- Evaluation of projected outcomes, including life years gained and distribution.
- Consideration of ethical implications, including age discrimination and public trust.
Main Results:
- Proponents estimate an additional 15,223 life years annually post-transplant.
- Critics raise concerns about unequal benefit distribution, potential age discrimination, and decreased live kidney donation.
- The proposal's benefits and shortcomings are weighed against existing concerns.
Conclusions:
- The proposed changes represent a necessary initial step towards balancing equity and efficiency in kidney allocation.
- Despite identified weaknesses, the proposal warrants careful consideration.
- Maintaining consistent expectations for patients and providers is crucial during implementation.
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