Should Children Be Given Priority in Kidney Allocation?
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Kidneys for transplantation are scarce, and many countries give priority to children in allocating them. This paper explains and criticizes the paediatric priority. We set out the relevant ethical principles of allocation, such as utility and severity, and the relevant facts to do with such matters as sensitization and child development. We argue that the facts and principles do not support and sometimes conflict with the priority given to children. We next consider various views on how age or the status of children should affect allocation. Again, these views do not support priority to children in its current form. Since distinctions based on age ought to be positively justified, the failure of all these attempts at justification implies that the priority to children is ethically mistaken. Finally, the paper points to evidence that the paediatric priority reduces the overall supply of kidneys, at least in the United States. Paediatric priority is a real-world policy that seems discriminatory, in some places probably reduces the supply of organs, has no robust official defence, and is unsupported by mainstream ethical principles. Consequently, it should be ended.
KeywordsKidney allocation Paediatric priority Age discrimination Justice Utility Live donation
We thank John McCall and Stephen Munn for very helpful discussions, and Monique Jonas, Geoff Kemp, Kathy Smits, and Steve Winter for their discussion and their incisive comments on a written draft. Thanks also to audiences at Starship Hospital, the University of Auckland, and Williams College.
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