The Quota-Allocation Formula: A Thought Experiment Integrating Wealth-Based Prioritisation into Organ Allocation

The ethics of organ transplantation spans three broad areas: the criteria that mark the end of life, the procurement of organs, and their distribution. The purpose of the present paper is to address this latter aspect. The task is to reconcile the idea of a paid system with organ allocation. Two jurisdictions are considered as points of reference: the United States and the Italian Republic. Both systems are primarily based on the principles of equity and medical urgency, albeit implemented through distinct frameworks. These two distinct sociocultural settings will be used to depict how organ allocation works today. Subsequently the idea of a market for organs will be analysed and a new device is introduced: the quota-allocation formula, which uses a randomised, fee-based quota system to balance fairness and utility by permitting a strictly bounded paid priority advantage only within medically equivalent categories, while pairing each paid advantage with a cost-free priority award for another patient and reinvesting the resulting revenue into the transplant system. Such a proposition illustrates how integrating market dynamics into organ transplantation could offer practical benefits, challenging the assumption that monetary incentives are inherently incompatible with ethical and equitable allocation systems.