microallocation - PHL116 Allocation of Scarce Medical...

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PHL116 Allocation of Scarce Medical Resources: Organs/Transplant Surgery and Exotic Life Saving Therapies I. Types of Medial Goods in High Demand but Short Supply Kidney Dialysis machines Crucial vaccines organs II. Types of Medical Goods in High Demand but not Affordable for most Certain medications Emergency room visits Hospital stays Surgical operations Functional imaging technologies Diagnostic laboratory tests In vitro feterilzation Bone marrow transplants Blood transfusions Genetic screening III. Ethical Problems with Allocation A. Historical Background In the late 1960’s in Seattle, Washington, the Artificial Kidney Center (responsible for allocation of kidney dialysis machines) organized an anonymous screening committee to choose from a list of candidates competing for life saving kidney-dialysis treatment. The committee used what are typically called “social worth” criteria. The committee attempted to calculate each candidate’s social worth, and allocation of the life-saving therapy was based upon how each candidate fared in the calculation. Nicholas Rescher, in his 1969 article, “The Allocation of Exotic Medical Lifesaving Therapy (ELT)” upholds social worth criteria as a necessary component in allocating ELT’s. George J. Annas in his 1985 article, “The Prostitute, the Playboy, and the Poet: Rationing Schemes for Organ Transplantation” rejects the use of social worth criteria as unfair and inequitable. Both authors attempt to specify criteria for the allocation of scarce medical resources. Today, the United Network for Organ Sharing (UNOS) oversees the allocation of organs in the United States. UNOS is a private not-for-profit organization that is based in Virginia. UNOS “administers the national Organ Procurement and Transplantation Network (OPTN) and the U.S. Scientific Registry on Organ Transplantation under contracts with the U.S. Department of Health and Human Services.” UNOS matches organ donors with recipients and ensures that organs are allocated in the most equitable way possible. It rejects the use of social worth criteria as a basis for allocation. This does not mean, however, that UNOS policies are not sometimes violated. Even with UNOS policies in place, the ethical question still arises—how should scarce medical resources such as organs be allocated? 1
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B. Problems with Microallocation – Shortage of Technology The paradigmatic case of an ELT is the Kidney Dialysis Machine. Hemodialysis , which is the function of a kidney dialysis, is used to treat renal failure. The machine filters out waste products from the blood that build up during cellular metabolism (e.g., salt, urea, creatine, potassium, uric acid) – a process that under normal conditions is performed by the kidneys. The average number of times per week a patient undergo hemodialysis is 3 times per week for 5 hours each time. Patients must adhere to a strict diet, show up for scheduled dialysis sessions, understand the need
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microallocation - PHL116 Allocation of Scarce Medical...

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