Status: Public Comment
Sponsoring Committee: Ethics Committee
Strategic Goal 2: Provide equity in access to transplants
Read the proposal and white paper (PDF; 1/2019)
Contact: Abigail Fox
The allocation policies for multi-organ transplant (MOT) have the potential to create inequity in the organ distribution process, either in the rate of transplantation or in the time to transplantation. Such potential inconsistencies may affect the patients who are awaiting MOT as well as those who are awaiting single organ transplantation (SOT) because both groups depend upon available organs from the same limited donor pool. Prioritization of MOT candidates and the allocation rules for each combination have not been standardized across the different organs. As a result, the current allocation system has generated confusion in the transplant community about the rationale for differences in MOT allocation plans between different organ combinations.
The OPTN/UNOS Ethics Committee (hereafter “The Committee”) performed an analysis of policy and relevant literature focusing on the potential conflict in the principles of equity and utility in the allocation of multi-organ transplants. Ultimately the Committee affirmed that MOT should reflect a balance between equity and utility, with the understanding that no system can maximize both. Because the ethical issues of equity and utility that MOT raises are common with all organ combinations, the ethical principles must be carefully considered and weighed in the development and modification of MOT policy. This white paper details the ethical dilemmas that arise from conflicts between equity and utility and the recommendations of the Committee regarding the allocation of multi-organ transplants.
The 2018 OPTN/UNOS Strategic Plan called for the OPTN to “measure equity in allocation, including geographic disparities and multi-organ disparities.” This white paper lays the foundation for other committees to clarify or modify existing multi-organ allocation policy and to do so in a consistent, principled manner, which aligns with the OPTN strategic goal to provide equity in access to transplant.