March 14, 2011 | Posted By Danielle Holley, JD, MS

Recently, the United Network for Organ Sharing (UNOS) issued a report seeking feedback on their new proposed allocation system for kidneys–a complete overhaul of the current system – which seeks to match kidney recipients with deceased donor organs based on age and health.  Click here for report.  It has been evident for a while that the system for allocating kidneys faces many problems—there is an ever-growing wait list with over 100,000 people currently on the list and significantly less donors than are needed.  The looming question, then, is how do we allocate life-saving limited resources?

The question of allocating scarce resources is often posed as a “priority problem” with several opposing options: (1) giving the scarce resource to the worst off, (2) using an utilitarian argument by focusing on the greatest overall good, or (3) using a first-come, first-served method.  Each of these options presents their own unique benefits and downfalls.  The current system tends to allocate based on first-come, first serve with compatability (but there are numerous stories over the years that note the ineffectivness or blatant violation of this).  The proposed system, however, adopts a more utilitarian argument, focusing on giving priority to those first with longest estimated survivial and then to a recipient within 15 years of the donor organ if the donor organ has a KDPI score of greater than or equal to twenty percent.  The overall goal of the proposed system is to increase the total life span following transplant.      

One possible critique of this system is that this results in “age discrimination.”  There is a recognized small decrease in rates of recipients in the age of 50 to 64 (41% to 35%) or over 65 (16% to 11%), while those between the ages of 18 and 34 or 35 and 49 have increased recipient rates (11% to 18% and 27% to 31% respectively).  (p.26)  It is important to note, however, that those aged 50 to 64 will still receive the greatest percentages of organs, based on the current donor age data, thus defeating the “age discrimination” claim.  In addition, the committee assures readers that the proposed allocation program is to ensure closer age match between donor and recipient and that older recipients still equally benefit with the same results as the current system provides.  In fact, the committee argues that “the proposed system provides better opportunities for all candidates to achieve as much of a normal lifespan as possible.”  (p.30)  The key phrase here is “as much as normal lifespan as possible.”  The goal is to distribute a scarce resource in the most just way on a societal level– balancing benefits and burdens and distributing kidneys fairly so that each group bears an equitable share.  The proposed system in no way proportionally favors or disfavors one group any more than the current system, but attempts to make the most out of a scarce resource.

Allocating live-saving scarce resources is a difficult subject and leads to marked discussion.  The proposed allocation is moving in the right direction, recognizing the need to maximize the benefit of the kidneys that are available in a just manner.  Nevertheless, the proposed system does not address some of the remaining glaring issues, including most importantly the need for an overall increase in organ donations.          

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