PHOENIX — There are many ways limited resources like kidneys can be allocated, but the key is to find a system that gives everyone, regardless of social or economic status, equal ability to access that resource, a speaker said here.
“A scarce resource could be an ICU bed. It could be a ventilator for coronavirus or it could be an organ,” Glen Cohen, JD, said during the Cutting Edge of Transplantation: Transplant Summit.
Cohen, who served on the ethics committee of the Organ Procurement Transplant Network (OPTN), which monitors the distribution of donated organs in the United States, discussed options on how scarce resources could be distributed. People like lotteries because the games create an “equal playing field” for those who need the resource, Cohen said. A second option, based on “first come, first served” is more common and recognizable to the general public, but allowing people to add their names to multiple waitlists around the country because they may have the financial ability to do so “is a means of giving some a leg up” in trying to find a kidney match.
A third option is “sickest first,” ie, patients who are experiencing the most burden or pain should get higher priority, Cohen said. A fourth principle would be youngest first or age-weighing so those who are older and have been on dialysis care longer should get placed higher on the list for organs. Others might argue it is difficult to set a cutoff based on age, because longevity has improved in many cases during the years, he said. “Who is to say what a good length of life is likely to be?’ Cohen said.
Cohen asked the audience about the “instrumental value” of distributing scarce resources. The idea is to reward people who have done good things for society, such as first responders, medical personnel, etc.
“Teachers have made a major contribution to society” and might be considered as candidates who could be placed higher on the list, he said. That might also apply to those who must risk their own health for others.
Utility, equity and respect for autonomy are key in the OPTN guiding principles of organ allocation, Cohen noted.
“There are lots of critics out there,” Cohen said. “Some say sickest first and first come, first served” are not fair ways of distributing organs. “It’s easy to be a critic; it’s hard actually to make policy.” – by Mark E. Neumann
Reference: Cohen G. Ethics of allocating a scarce resource: OPTN legal and regulatory framework. Presented at: Cutting Edge of Transplantation: Transplant Summit. March 5-7, 2020; Phoenix.
Disclosure: Cohen reports no relevant financial disclosures.