An Ethical Analysis of Allocating Organs Out of Sequence

Purpose of Review: Recently, in response to the problem of underutilization of organs available for transplant, there has been an increase in organs allocated out of sequence (AOOS). AOOS occurs when Organ Procurement Organizations and/or transplant programs deviate from the calculated rank-order list of potential recipients on the national organ waiting list. While AOOS attempts to decrease organ nonuse and improve organ placement efficiency, this practice raises questions about fairness and public trust. To address these concerns, the Organ Procurement and Transplant Network Ethics Committee undertook an ethical analysis of AOOS, a condensed version of which we present here. Recent Findings: While AOOS represents a tempting solution to nonuse, we argue it is not fully justified by utility, as the data remain unclear whether AOOS has a significant positive impact on organ nonuse. There are further concerns regarding the ethical principles of respect for persons, transparency, and equity. Summary: We conclude that AOOS should not come to be regarded as the prevailing solution to mounting pressure placed on the transplant community precipitated by nonuse, and that the transplant community should strive to develop system-wide solutions to organ waste though the development of a more transparent and comprehensive policy framework.