Principles for allocation of scarce medical interventions

Persad, Govind; Wertheimer, Alan; Emanuel, Ezekiel J

doi:10.1016/s0140-6736(09)60137-9

Cited by 931Ethics and bioethics in healthcareOrgan Donation and TransplantationHealth Systems, Economic Evaluations, Quality of Life

Principles for allocation of scarce medical interventions

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Persad, Govind, Wertheimer, Alan, Emanuel, Ezekiel J·2009·The Lancet

DOI 10.1016/s0140-6736(09)60137-9

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Abstract

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system-the complete lives system-which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.

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Self-citation

Authors: Persad, G., Wertheimer, A., & Emanuel, E. J.
Affiliations: National Institutes of Health (US)
Corresponding author: Emanuel, Ezekiel J
ORCID: Persad, Govind
Emanuel, Ezekiel J
Venue: The Lancet
Publisher: Elsevier BV
Published: 2009-01
Volume: 373
Issue: 9661
Pages: 423-431
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(09)60137-9
OpenAlex: W2133393736
Cited by: 929
References: 91
Citations by year: 2026: 72 · 2025: 46 · 2024: 52 · 2023: 56 · 2022: 82 · 2021: 115 · 2020: 119 · 2019: 35 · 2018: 29 · 2017: 39 · 2016: 44 · 2015: 31 · 2014: 36 · 2013: 29 · 2012: 53
FWCI: 47.73
Type: journal article
Language: en
Open access: green
philarchive.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
PhilPapers (PhilPapers Foundation) (submittedVersion)
Colorado Law Scholarly Commons (University of Colorado Colorado Springs) (submittedVersion)
eYLS (Yale Law School) (submittedVersion)
DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Funders: U.S. Department of Health and Human Services
National Institutes of Health
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Organ Donation and Transplantation
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords: allocation of scarce medical resources, organ allocation, vaccine allocation, allocation principles, equal treatment, social utility, quality-adjusted life years, disability-adjusted life years, lottery allocation, prognosis, instrumental values, resource allocation ethics
MeSH terms: Age Factors, Ethics, Medical, Health Priorities, Humans, Morals, Prognosis, Health Care Rationing, Patient Selection, Quality-Adjusted Life Years, Resource Allocation

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