We study the allocation of cadaveric donor kidneys for transplantation based merely on waiting time. This simple allocation rule turns out to possess very attractive ethical and medical properties. Current allocation rules, on the other hand, violate some basic requirements of distributive justice. Perhaps for fear of exacerbating these problems, these rules also fail to consider criteria such as sex, age and race although certain combinations of these criteria are known to affect graft survival rates. We demonstrate that allocation by (...) waiting time automatically protects disadvantaged patient types and puts them in a near to optimal position. The inclusion of sex, age and race will therefore not lead to morally unacceptable allocations. This allows individual patients to improve the expected survival time of their graft relative to the status quo without being penalized by the allocation rule. Moreover, decisions ab out when to start compromising on expected graft survival rates in favour of shorter waiting times are made locally by patients and their medical advisers rather than by a centralized protocol. (shrink)

In the Eurotransplant region transplantable kidneys from cadaveric donors are allocated according to the Wujciak-Opelz algorithm. This paper shows that the algorithm as it stands fulfils certain normative standards of a more formal nature while violating others. In view of these insights, it is explored how the algorithm could perhaps be improved. Even if issues of substantial rather than formal adequacy need to be addressed separately, analyses as presented in this paper can prepare the ground for a discussion of substantive (...) normative issues. In any event, axiomatic accounts can tell us something about what we are in fact doing when using a procedure like the Wujciak-Opelz algorithm. (shrink)