The ethical debate over child priority in post-mortem organ allocation: A scoping review and practical-ethical outlook.

Background: Organ allocation guidelines in many countries give children relative priority, but the normative justification of child priority is seldom articulated.

Methodology: We conducted a scoping review of the recent international literature (2013-2019) to identify moral positions and normative frameworks to justify or criticize pediatric priority in all kind of organ allocation. We identified 11 relevant papers.

Results: Our analysis revealed a complex juxtaposition of pro and contra argumentations along three main normative lines: a) equal treatment of each individual, b) individual benefit, and c) social benefit and the public good. The general type of argument can be found independent of the organ allocated. For each of these three lines we identified and categorized two types of argumentations: those in favor and those critical of the priority rule. Additionally, we discuss a problematic issue that has not yet been mentioned in the literature, namely the effects of age thresholds related to child-priority rules in organ allocation. We illustrate this problem with an analysis of selected German data with allocated postmortal kidneys and livers. These data show non-normal distributions of organ transplantations and waiting times for patients between the ages of 16 and 19.

Discussion: Our overview serves as a matrix to reconsider existing guideline policy. The review can assist policy makers or experts on organ allocation committees in increasing the transparency of child priority rules, in explaining their justifications, and in reforming existing guidelines.