Critically appraising the 2018 United Network for Organ Sharing donor allocation policy

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Lauren K. Truby ◽  
Maryjane Farr ◽  
Veli K. Topkara
1999 ◽  
Vol 8 (3) ◽  
pp. 311-320 ◽  
Author(s):  
KENNETH EINAR HIMMA

The United Network for Organ Sharing (UNOS) recently changed the policy by which donor livers are allocated to liver failure patients in the United States. Formerly, all liver failure patients were characterized as status 1 and placed at the top of the transplant list. Under the new policy, only patients with liver failure due to acute illness (“ALF patients”) are eligible for status 1; patients with liver failure due to chronic liver disease (“CLF patients”) are characterized as status 2. Since donor organs are allocated first to status 1 patients and then to status 2 patients, the new policy moves all CLF patients down on the waiting list relative to all ALF patients. This means that some livers that would have gone to CLF patients under the old policy will now go to ALF patients. Accordingly, while the new policy will likely increase the number of ALF patients saved, it will also increase the number of deaths among CLF patients waiting for a transplant.


2020 ◽  
Vol 75 (11) ◽  
pp. 1076
Author(s):  
Jonathan Nattiv ◽  
Grace Liu ◽  
Pooya Banankhah ◽  
Joseph Rahman ◽  
Kruti Pandya ◽  
...  

2000 ◽  
Vol 9 (2) ◽  
pp. 275-280 ◽  
Author(s):  
James Burdick

The critique of the United Network for Organ Sharing (UNOS) liver allocation policy by Kenneth Himma has flaws related to the complexities and evolutionary nature of the field. Recent improvements in transplantation have achieved national attention of this sort. There has been an evolution, unequaled elsewhere in medicine, of a national data set and national rules. The transplant community might have been more effective in communicating the details of this, and the problems associated with organ allocation policy. The novelty and complexity of the new rules understandably can produce misleading conclusions.


Water Policy ◽  
2006 ◽  
Vol 8 (1) ◽  
pp. 1-13 ◽  
Author(s):  
Ramesh Bhatia ◽  
John Briscoe ◽  
R. P. S. Malik ◽  
Lindy Miller ◽  
Smita Misra ◽  
...  

The state of Tamil Nadu, India, is in the grips of a water crisis, with demand far outstripping supply. As the economy of the state grows, this crisis is going to become ever more serious. To date the focus of state water policy has been on trying to augment supplies, from within the state (even from desalinization) and from neighboring states. In addition, the water use is regulated in a way that does not encourage the highest value uses. International experience shows that supply-side measures must be complemented by demand-side measures and that practice must move away from fixed, command-and-control allocation policies towards flexible allocation mechanisms, which facilitate the voluntary movement of water from low to high-value uses. This study addresses the question of whether such a change in allocation policies is worth doing. It addresses this question by developing optimization models for each of the 17 river basins in Tamil Nadu (including an assessment of the economic value of water in different end-uses – agriculture, domestic and industry), then using an input–output model embedded in a social accounting matrix (SAM), to assess the impact of these changes on the state economy and on different rural and urban employment groups. The results suggest that a shift to a flexible water allocation system would bring major environmental, economic and social benefits to the state. Compared with the current “fixed sectoral allocation” policy, a flexible allocation policy would, in 2020, result in 15% less overall water used; 24% less water pumped from aquifers; 20% higher state income; with all strata, rich and poor, benefiting similarly, with one important exception, that of agricultural laborers.


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