Justifying Organ Allocation Out of Sequence

Area of Science:

• Medical Ethics
• Transplantation Medicine
• Health Policy

Background:

• Allocation Out of Sequence (AOOS) is increasingly prevalent in US organ transplantation, with 20% of kidneys transplanted outside the standard sequence by end-2024.
• AOOS faces criticism for failing to prevent organ nonuse, address allocation inefficiencies, ensure transparency, and potentially worsening transplant disparities.

Purpose of the Study:

• To outline factors contributing to the expansion of AOOS in organ transplantation.
• To evaluate the ethical and normative arguments for and against AOOS.
• To propose considerations for revising AOOS policies based on procedural justice.

Main Methods:

• Review of ethical concerns and regulatory scrutiny surrounding AOOS.
• Analysis of normative arguments for and against AOOS.
• Application of a constructivist framework to assess AOOS against principles of procedural justice.

Main Results:

• AOOS expansion is driven by various factors, though specific drivers are not detailed.
• The primary ethical critique of AOOS centers on violations of procedural justice.
• AOOS conflicts with the principle that allocation policies should stem from collective agreement.

Conclusions:

• AOOS undermines procedural legitimacy in organ allocation.
• Revisions to the AOOS pathway are needed.
• Establishing shared norms is crucial for ensuring the legitimacy of organ allocation policies.