Principles of kidney allocation

Abstract

It is generally accepted that a model for kidney allocation should be equitable. The two principles of primary importance for policy decisions concerning allocation of donor organs in organ transplantations are medical utility and justice [1,2]. These allocation principles are usually explained with regard to the individual transplant candidate. Patient selection based upon medical utility points towards the predictably best outcome of a donor organ in a transplantation, i.e. the maximum number of patient—years of graft function. Selection based upon justice is related to giving an organ to those who are worst off, either at the particular moment that an organ is to be allocated or from the ‘over-a-lifetime’ perspective, so that their condition will be improved. Strictly speaking, these two principles are mutually conflicting.