Rationing life-saving resources--how should allocation policies be assessed in solid organ transplantation.

Because the demand for solid organ transplantation exceeds the availability of donated grafts, there needs to be rationing for this life-saving procedures. Criteria for selection of patients to a national transplant list and allocation of donated organs should be transparent yet there is no consistent approach to the development of such guidelines. It is suggested that selection and allocation policies should comply with minimum standards including defining of aims of the allocation process and desired outcome (whether maximizing benefit or utility or ensuring equity of access), inclusion and exclusion criteria, criteria for futility and suspension and removal from the transplant list, appeals processes, arrangements for monitoring and auditing outcomes and processes for dealing with noncompliance. Furthermore, guidelines must be consistent with legislation even though this may compete with public preference. Guidelines must be supported by all stakeholders (including health-care professionals, donor families and potential transplant candidates). However, there must also be flexibility to allow for exceptions and to support innovation and development.