PMID- 32231786
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2054-3581 (Print)
IS  - 2054-3581 (Electronic)
IS  - 2054-3581 (Linking)
VI  - 7
DP  - 2020
TI  - Policy Challenges for Organ Allocation in an Era of "Precision Medicine".
PG  - 2054358120912655
LID - 10.1177/2054358120912655 [doi]
LID - 2054358120912655
AB  - There is increasing interest in the use of precision medicine tools and 
      evidence-based outcome measures for donor-recipient matching to optimize 
      transplant outcomes. Although the shift toward greater precision can provide 
      health and resource benefits, it may be perceived as conflicting with both 
      established equity-focused organ allocation norms and the legal and ethical 
      obligations of health care providers and related institutions. With increasing 
      evidence that various forms of human leukocyte antigen (HLA) mismatch and/or 
      prognostic biomarkers can affect outcomes, the tension between maximizing utility 
      and ensuring equity seems likely to intensify. In Canada, health care providers 
      are generally required by law to put the interests of their patient, such as 
      access to an organ, above the needs of the health care system and other patients. 
      In addition, transplantation right of access lawsuits, which have been successful 
      in the past, could affect the implementation of precision approaches. These legal 
      tensions could be further heightened by media representations, which have 
      historically favored strong rights of access. When implementing new precision 
      technologies in organ allocation, there will be a recurrent need for policymakers 
      to revisit the balance of equity and utility and to assess how to craft rules 
      that reflect our society's conception of a fair allocation system.
CI  - (c) The Author(s) 2020.
FAU - Caulfield, Timothy
AU  - Caulfield T
AUID- ORCID: 0000-0001-5471-6184
AD  - Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada.
FAU - Murdoch, Blake
AU  - Murdoch B
AD  - Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada.
FAU - Sapir-Pichhadze, Ruth
AU  - Sapir-Pichhadze R
AUID- ORCID: 0000-0003-0745-004X
AD  - Department of Medicine, McGill University, Montreal, Quebec, Canada.
FAU - Keown, Paul
AU  - Keown P
AD  - Faculty of Medicine, The University of British Columbia, Vancouver, Canada.
LA  - eng
PT  - Editorial
DEP - 20200320
PL  - England
TA  - Can J Kidney Health Dis
JT  - Canadian journal of kidney health and disease
JID - 101640242
PMC - PMC7088188
OTO - NOTNLM
OT  - allocation policy
OT  - organ allocation
OT  - precision medicine
OT  - professional obligations
OT  - public representations
OT  - right of access
COIS- Declaration of Conflicting Interests: The author(s) declared no potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article.
EDAT- 2020/04/02 06:00
MHDA- 2020/04/02 06:01
PMCR- 2020/03/20
CRDT- 2020/04/02 06:00
PHST- 2019/10/23 00:00 [received]
PHST- 2020/01/29 00:00 [accepted]
PHST- 2020/04/02 06:00 [entrez]
PHST- 2020/04/02 06:00 [pubmed]
PHST- 2020/04/02 06:01 [medline]
PHST- 2020/03/20 00:00 [pmc-release]
AID - 10.1177_2054358120912655 [pii]
AID - 10.1177/2054358120912655 [doi]
PST - epublish
SO  - Can J Kidney Health Dis. 2020 Mar 20;7:2054358120912655. doi: 
      10.1177/2054358120912655. eCollection 2020.