Cutting in line? Ethical and clinical perspectives on the allocation out-of-sequence of deceased donor organs in the United States

This panel gathers transplant experts and patients to offer varied and nuanced perspectives on the ethical and clinical implications of allocation out-of-sequence (AOOS) deceased donor organs. Recently highlighted in a New York Times article, AOOS is rising in frequency with 19% of deceased donor kidneys being offered outside of the match algorithm specified in national policy guidelines.

The first speaker (transplant surgeon, bioethicist) will describe trends in AOOS, reasons for the increasing use AOOS, how AOOS offers are made, and what factors clinicians take into account when deciding who should receive an AOOS organ. They will also describe alternative allocation mechanisms that can increase the use of imperfect organs without compromising equity. The second speaker (transplant recipient, psychologist) will offer comments on AOOS based on their lived experiences as a kidney transplant recipient and their professional expertise as a psychologist. The third speaker (ethicist, medical humanities) will raise questions intended to involve the audience in an ethical analysis of AOOS, exploring the tensions and trade-offs between utility, equity, and transparency within the transplant system. This discussion will also highlight the importance of respect for donors/donor families and the need to maintain trust in the allocation system. The fourth speaker (philosopher) will summarize recent media coverage and rapidly shifting policy changes. Next, they will discuss the resultant ethical opportunities and challenges facing clinicians, transplant centers, and OPOs, as well as the ethical significance of public perceptions regarding AOOS.

Each speaker will give a 9-minute-long presentation, reserving 20 minutes for audience Q&A.

Keywords: Organ transplant, Equity, Health Policy