Equal Opportunity Supplemented by Fair Innings: Equity and Efficiency in Allocating Deceased Donor Kidneys

  1. L. F. Ross1,2,7,*,
  2. W. Parker3,
  3. R. M. Veatch4,
  4. S. E. Gentry5,6,
  5. J. R. Thistlethwaite, Jr.7

Article first published online: 15 JUN 2012

DOI: 10.1111/j.1600-6143.2012.04141.x

Issue

American Journal of Transplantation

American Journal of Transplantation

Volume 12, Issue 8, pages 2115–2124, August 2012

Additional Information

How to Cite

Ross, L. F., Parker, W., Veatch, R. M., Gentry, S. E. and Thistlethwaite, Jr., J. R. (2012), Equal Opportunity Supplemented by Fair Innings: Equity and Efficiency in Allocating Deceased Donor Kidneys. American Journal of Transplantation, 12: 2115–2124. doi: 10.1111/j.1600-6143.2012.04141.x

Author Information

  1. 1

    Department of Pediatrics

  2. 2

    MacLean Center for Clinical Medical Ethics

  3. 3

    Pritzker School of Medicine, University of Chicago, Chicago, IL

  4. 4

    Kennedy Institute of Ethics, Georgetown University, Washington, DC

  5. 5

    Department of Mathematics, U.S. Naval Academy, Annapolis, MD

  6. 6

    Department of Surgery, Johns Hopkins University, Baltimore, MD

  7. 7

    Section of Transplantation, Department of Surgery, University of Chicago, Chicago, IL

* Lainie Friedman Ross, lross@uchicago.edu

Publication History

  1. Issue published online: 27 JUL 2012
  2. Article first published online: 15 JUN 2012
  3. Received 29 November 2011, revised 07 March 2012 and accepted for publication 09 March 2012

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Keywords:

  • Age-matching;
  • efficiency;
  • equal opportunity;
  • equity;
  • ethics;
  • fair innings;
  • kidney transplantation;
  • lifespan equity;
  • organ allocation;
  • public policy;
  • utility

For 7 years, the Kidney Transplantation Committee of the United Network for Organ Sharing/Organ Procurement Transplantation Network has attempted to revise the kidney allocation algorithm for adults (≥18 years) in end-stage renal disease awaiting deceased donor kidney transplants. Changes to the kidney allocation system must conform to the 1984 National Organ Transplant Act (NOTA) which clearly states that allocation must take into account both efficiency (graft and person survival) and equity (fair distribution). In this article, we evaluate three allocation models: the current system, age-matching and a two-step model that we call “Equal Opportunity Supplemented by Fair Innings (EOFI)”. We discuss the different conceptions of efficiency and equity employed by each model and evaluate whether EOFI could actually achieve the NOTA criteria of balancing equity and efficiency given current conditions of growing scarcity and donor-candidate age mismatch.

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