Age should not be considered in the allocation of deceased donor kidneys

In this manuscript, we examine what role age can morally play in the allocation of deceased donor kidneys for transplantation into adult candidates. Our focus is on the equity concerns raised by recent proposals that give younger adults in end-stage renal disease priority to more and better deceased donor kidneys. We begin with a description of four models: the current allocation method ("baseline proposal"), the two models offered by the Kidney Transplant Committee in February 2011: a pure ±15 years age-matching model and a 20/80 proposal (http://optn.transplant.hrsa.gov/SharedContentDocuments/KidneyConceptDocument.PDF), and a new model entitled Equal Opportunity supplemented by Fair Innings (EOFI) described by Ross et al. earlier this year. We then consider the requirement of the National Organ Transplantation Act (NOTA) of 1984 that allocation policies balance efficiency and equity. The models all define efficiency as promoting graft and patient survival but use various conceptions of equity. We discuss the various conceptions of equity employed in the various models. We show that only the new proposal, EOFI, can meet the NOTA requirements using a multiprincipled equity approach to kidney allocation.