LAUSR

While the coronavirus disease 2019 (COVID19) pandemic has focused public and medical attention on how limited lifesaving medical resources must sometimes be rationed,1 the transplantation medicine community has been struggling with this question for decades. Despite increases in the numbers of organ donors, both deceased and living, the continuing shortage of organs not only means that many patients who might benefit from transplantation are not being referred or listed, but as many as one in seven people listed for a transplant die or become too sick before an organ becomes available.2,3 Consequently, access to lifesaving organs is, in effect, rationed, undertaken according to agreed guidelines that vary between jurisdictions and depend, in part, on the balance between the availability of organs and the clinical need. The criteria for selecting recipients and for allocating organs include need (priority for the sickest patients), equity, justice, utility, benefit, and the avoidance of futility.4