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Review
. 2023 Dec 1;28(6):452-456.
doi: 10.1097/MOT.0000000000001103. Epub 2023 Sep 21.

The history of ethical principles in liver transplant organ allocation in the United States: how historical and proposed allocations system fare in balancing utility vs. urgency and justice vs. pragmatism

Aaron Ahearn  1
Affiliations
Review

The history of ethical principles in liver transplant organ allocation in the United States: how historical and proposed allocations system fare in balancing utility vs. urgency and justice vs. pragmatism

Aaron Ahearn. Curr Opin Organ Transplant. .

Abstract

Purpose of review: The United States (US) liver transplant community is processing changes to the allocation system and developing a new proposal that will result in even greater change. This review evaluates the ethical implications of these decisions, focusing on two sets of competing ethical principles (Urgency vs. Utility and Justice vs. Pragmatism).

Recent findings: About four years ago, the Organ Procurement and Transplantation Network (OPTN) implemented the Acuity Circle Model to replace the geographic boundaries of organ procurement organizations (OPOs). Here, we review how effectively this model reduced regional variation in access and improved waitlist survival. Likewise, the OPTN is planning to transition to a continuous distribution model which will redefine the scoring systems for allocation. We will discuss how the ethical priorities discussed above should be considered while developing the new system.

Summary: Every change in organ allocation policy must balance competing ethical imperatives. Although our community's emphasis on urgency over utility is appropriate, we should study the potential benefits of considering utility in the system. Meanwhile, our push for more Justice in the system should remain our imperative and Pragmatism should only be considered to minimize the costs of these changes.

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References

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    1. US Department of Health and Human Services. Organ Procurement and Transplantation Network (OPTN). Ethical principles in the allocation of human organs. 2015. Available at: http://optn.transplant.hrsa.gov/resources/ethics/ethical-principles-in-t... [Accessed 15 July 2023].
    1. US Department of Health and Human Services. Organ Procurement and Transplantation Network (OPTN). Two year montioring report of liver and intestine acuity circle allocation removal of DSA and region as units of allocation. 2022 [Accessed 10 July 2023].