Related to Nikola’s post below on the proposed revisions to the deceased donor kidney allocation policy, Al Roth has posted some interesting commentary from OPTN/UNOS Kidney Transplantation Committee Chair John Friedewald (in response to a query on a list serve):
“The current proposal for kidney allocation from the UNOS kidney committee is what it is not because it was the first thing we thought of, and “wow, it’s perfect” but rather it is the product of 8 years of trial and error, consensus building, and compromise. To state that EOFI takes into account both equity and efficiency would seem to suggest that the current UNOS proposal does not. How could this be? We have tried over 50 different methods of allocation and simulated them (which has not happened yet with EOFI). And with each simulation, we view the results and how the system affects all sorts of different groups (NOT just age, but blood type, ethnic groups, sensitized patients, the effects on organ shipping, the effects on real efficiency in the system (the actual logistics). And we have seen that some methods of allocation can generate massive utility (or efficiency in your terminology). We can get thousands of extra life years out of the current supply of organs. But in each instance, we have made concessions in the name of equity. The current proposal does not increase or decrease organs to any age group by more than 5% (compared to current). This has been our compromise on equity. What we see in utility/efficiency is an extra 8000+ years lived each year with the current supply of organs. So the current policy has done a tremendous amount to balance equity and utility. And we have left thousands of life years lived on the table in the name of equity. Now you may argue that we have not done enough in that regard, but rest assured, we have given equity hundreds of hours of consideration.