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.
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A point made by Capitaine et al. 2014. They explain various difficulties in paediatric research that make it hard to show what transplants do for children. We would add that the paediatric priority makes it hard to find a comparison group of children with kidney failure who have not been transplanted.
Veatch (2000) argues that age bias should extend across the whole range, but instead of a smooth decline, he favours a stronger but rapidly declining priority to children age nought to ten and then ten-year-olds get a small priority over those older that slowly dwindles across the rest of the life span. But he gives no reason for this priority judgement.
The material in this paragraph is taken from Axelrod et al. (2010, 995). Magee et al. write of the “great concern” about the “higher priority granted for deceased donors, which has resulted in a reduction of living donor transplantation” (2008, 937). Wolff et al. 2014 claim the priority to children has caused a similar reduction in supply in Quebec.
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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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Wilkinson, T.M., Dittmer, I.D. Should Children Be Given Priority in Kidney Allocation?. Bioethical Inquiry 13, 535–545 (2016). https://doi.org/10.1007/s11673-016-9737-x
- Kidney allocation
- Paediatric priority
- Age discrimination
- Live donation