Negotiating Values: Implementing Rubric Change in Transplant Organ Allocation

• In Event: Understanding the Impact of Health Policy Problems in American Society

Abstract

Over its first three decades the Organ Procurement and Transplantation Network (OPTN), an institution of stakeholder rulemaking, incrementally adjusted the allocation rules for transplant organs to take account of changing medical evidence and concerns about racial and geographic disparities. The resulting allocation rules became increasingly complex with vestiges of geographic boundaries. In 2018 the OPTN adopted the policy of replacing the existing category-based organ allocation rules with rules that would replace category-based priorities with individualized priorities. This “continuous distribution” initiative requires the implementation of the individualized priorities for each of the transplant organs. The initiative draws on the tacit knowledge of the transplant professionals who participate in OPTN committees, systematic evidence and modelling, and exercises, such as the Analytic Hierarchy Process and public comment, to elicit community input. The exceptional transparency of OPTN processes provides a rare opportunity to observe an organization making explicit and very consequential value tradeoffs. This paper draws on documentary records, interviews, and direct observation of OPTN committee meetings to determine the roles of evidence and community input in the development of continuous distribution rules for lungs (completed) and kidneys (underway). Specifically, it considers the conditionality of the weighting of goals on technical information and decisions. It also sheds light on managing the implementation of radical organizational change.

Author

• David L. Weimer, University of Wisconsin - Madison