Hope versus efficiency in organ allocation.

Previous ethical analyses of organ allocation policies have addressed the trade-off between giving organs to urgent versus non-urgent patients, overlooking the process by which patients become urgent in the first place. This article proposes three criteria for assessing the performance of organ allocation rules that take into account the dynamic nature of patient health. An equitable policy is one under which patients' probability of receiving a transplant is equal at listing. Efficiency captures the goal of giving organs to patients when their benefit from transplantation is greatest. Hope implies that patients should believe that they have a reasonable chance of receiving an organ. The sickest first policy, which is currently used to prioritize patients, is hope-preserving, but may be inefficient. As demand grows relative to supply, patients will only receive an organ once they have reached the sickest status category.