Equal opportunity supplemented by fair innings: Equity and efficiency in allocating deceased donor kidneys

L. F. Ross, W. Parker, R. M. Veatch, S. E. Gentry, J. R. Thistlethwaite

Research output: Contribution to journalArticlepeer-review


For 7 years, the Kidney Transplantation Committee of the United Network for Organ Sharing/Organ Procurement Transplantation Network has attempted to revise the kidney allocation algorithm for adults (≥18 years) in end-stage renal disease awaiting deceased donor kidney transplants. Changes to the kidney allocation system must conform to the 1984 National Organ Transplant Act (NOTA) which clearly states that allocation must take into account both efficiency (graft and person survival) and equity (fair distribution). In this article, we evaluate three allocation models: the current system, age-matching and a two-step model that we call "Equal Opportunity Supplemented by Fair Innings (EOFI)". We discuss the different conceptions of efficiency and equity employed by each model and evaluate whether EOFI could actually achieve the NOTA criteria of balancing equity and efficiency given current conditions of growing scarcity and donor-candidate age mismatch. The authors develop a multiprinciple approach to ethically justify allocation of younger deceased donor kidneys to younger adult recipients meeting the National Organ Transplant Act criteria of balancing equity and efficiency. See editorial by Gill on page 1973.

Original languageEnglish (US)
Pages (from-to)2115-2124
Number of pages10
JournalAmerican Journal of Transplantation
Issue number8
StatePublished - Aug 2012


  • Age-matching
  • efficiency
  • equal opportunity
  • equity
  • ethics
  • fair innings
  • kidney transplantation
  • lifespan equity
  • organ allocation
  • public policy
  • utility

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


Dive into the research topics of 'Equal opportunity supplemented by fair innings: Equity and efficiency in allocating deceased donor kidneys'. Together they form a unique fingerprint.

Cite this