Equity and Survival Benefit in Deceased Donor Kidney Allocation: A Dilemma

A shortage in deceased donor kidneys for transplantation has persisted for decades. In their report "Realizing the Promise of Equity in the Organ Transplantation System," the US National Academies urge the study of "survival benefit" as a potentially equity-promoting criterion for allocating these life-enhancing and preserving organs. But the report generates a dilemma. Its account of equity is amenable to two interpretations. On one interpretation, using survival benefit to determine priority for transplantation would frequently be inequitable. On the other interpretation, equity would fail to justify the use of survival benefit as an allocation criterion. Indeed, the latter reading would leave survival benefit's use no more justified by equity considerations than the use of "longevity matching," a practice that, the report implies, diminishes the chances of transplant for minority candidates. This article puts in doubt whether survival benefit is a tool suited to promote equity in deceased donor kidney allocation.