Allocation of Indivisible Life-Saving Goods With Both Intrinsic and Relational Quality: The New Deceased-Donor Kidney Allocation System

Abstract

Allocation of scarce heterogeneous life-saving goods confronts society with profound challenges that are analytically complex and morally laden. Deceased-donor kidneys for transplant are heterogeneous in terms of relational and intrinsic quality. In 2014, the Organ Procurement and Transplantation Network implemented a new allocation system that more explicitly takes account of intrinsic quality. We trace the evolution of the new allocation system with particular attention to the role of evidence and the ways that concerns about equity were solicited, assessed, and taken into account in modifying the original proposal. These deliberations show the potential for stakeholder rulemaking to integrate evidence and values.