Allocation of Organs and Other Scarce Medical Resources

The WSMA has established the following guidelines regarding ethical considerations in the allocation of organs and other scarce medical resources among patients:

1. Decisions regarding the allocation of scarce medical resources among patients should consider only ethically appropriate criteria relating to medical need.
   1. These criteria include likelihood of benefit, urgency of need, change in quality of life, duration of benefit, and, in some cases, the amount of resources required for successful treatment. In general, only very substantial differences among patients are ethically relevant; the greater the disparities, the more justified the use of these criteria become. In making quality of life judgments, patients should first be prioritized so that extremely poor outcomes are avoided; then patients should be prioritized to change in quality of life, but only when there are very substantial differences among patients.
   2. Research should be pursued to increase knowledge of outcomes and thereby improve the accuracy of these criteria.
   3. Non-medical criteria, such as ability to pay, social worth, perceived obstacles to treatment, patient contribution to illness, or past use of resources should not be considered.
2. Allocation decisions should respect the individuality of patients and the particulars of individual cases as much as possible.
   1. All candidates for treatment must be fully considered according to ethically appropriate criteria relating to medical need.
   2. When very substantial differences do not exist among potential recipients of treatment on the basis of these criteria, a "first come, first served" approach or some other equal-opportunity mechanism should be employed to make final allocation decisions.
   3. Though there are several ethically acceptable strategies for implementing these criteria, no single strategy is ethically mandated. Acceptable approaches include a three-tier system, a minimal threshold approach, and a weighted formula.
3. Decision-making mechanisms should be objective, flexible and consistent to ensure that all patients are treated equally. The nature of the physician-patient relationship entails that physicians of patients competing for a scarce resource must remain advocates for their patients, and therefore should not make the actual allocation decisions.
4. Patients must be informed by their physicians of allocation criteria and procedures, as well as their chances of receiving access to scarce resources. This information should be in addition to the customary information regarding the risks, benefits, and alternatives to any medical procedure. Patients denied access to resources have the right to be informed of the reasoning behind the decision.
5. The allocation procedures of institutions controlling scarce resources should be disclosed to the public as well as subject to regular peer review from the medical profession.
6. Physicians should continue to look for innovative ways to increase the availability of and access to scarce medical resources so that, as much as possible, beneficial treatments can be provided to all who need them.

(JC Rpt E, A-94) (Reaffirmed A-17)

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Abbreviations for House of Delegates report origination:

EC – Executive Committee; BT – Board of Trustees; CPA – Council on Professional Affairs; JC – Judicial Council; CHS – Community and Health Services