Inconsistent values and algorithmic fairness: a review of organ allocation priority systems in the United States.

IF 3 1区 哲学 Q1 ETHICS BMC Medical Ethics Pub Date : 2024-10-17 DOI:10.1186/s12910-024-01116-x
Reid Dale, Maggie Cheng, Katharine Casselman Pines, Maria Elizabeth Currie
{"title":"Inconsistent values and algorithmic fairness: a review of organ allocation priority systems in the United States.","authors":"Reid Dale, Maggie Cheng, Katharine Casselman Pines, Maria Elizabeth Currie","doi":"10.1186/s12910-024-01116-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The Organ Procurement and Transplant Network (OPTN) Final Rule guides national organ transplantation policies, mandating equitable organ allocation and organ-specific priority stratification systems. Current allocation scores rely on mortality predictions.</p><p><strong>Methods: </strong>We examined the alignment between the ethical priorities across organ prioritization systems and the statistical design of the risk models in question. We searched PubMed for literature on organ allocation history, policy, and ethics in the United States.</p><p><strong>Results: </strong>We identified 127 relevant articles, covering kidney (19), liver (60), lung (24), and heart transplants (23), and transplant accessibility (1). Current risk scores emphasize model performance and overlook ethical concerns in variable selection. The inclusion of race, sex, and geographical limits as categorical variables lacks biological basis; therefore, blurring the line between evidence-based models and discrimination. Comprehensive ethical and equity evaluation of risk scores is lacking, with only limited discussion of the algorithmic fairness of the Model for End-Stage Liver Disease (MELD) and the Kidney Donor Risk Index (KDRI) in some literature. We uncovered the inconsistent ethical standards underlying organ allocation scores in the United States. Specifically, we highlighted the exception points in MELD, the inclusion of race in KDRI, the geographical limit in the Lung Allocation Score, and the inadequacy of risk stratification in the Heart Tier system, creating obstacles for medically underserved populations.</p><p><strong>Conclusions: </strong>We encourage efforts to address statistical and ethical concerns in organ allocation models and urge standardization and transparency in policy development to ensure fairness, equitability, and evidence-based risk predictions.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483980/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Medical Ethics","FirstCategoryId":"98","ListUrlMain":"https://doi.org/10.1186/s12910-024-01116-x","RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ETHICS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: The Organ Procurement and Transplant Network (OPTN) Final Rule guides national organ transplantation policies, mandating equitable organ allocation and organ-specific priority stratification systems. Current allocation scores rely on mortality predictions.

Methods: We examined the alignment between the ethical priorities across organ prioritization systems and the statistical design of the risk models in question. We searched PubMed for literature on organ allocation history, policy, and ethics in the United States.

Results: We identified 127 relevant articles, covering kidney (19), liver (60), lung (24), and heart transplants (23), and transplant accessibility (1). Current risk scores emphasize model performance and overlook ethical concerns in variable selection. The inclusion of race, sex, and geographical limits as categorical variables lacks biological basis; therefore, blurring the line between evidence-based models and discrimination. Comprehensive ethical and equity evaluation of risk scores is lacking, with only limited discussion of the algorithmic fairness of the Model for End-Stage Liver Disease (MELD) and the Kidney Donor Risk Index (KDRI) in some literature. We uncovered the inconsistent ethical standards underlying organ allocation scores in the United States. Specifically, we highlighted the exception points in MELD, the inclusion of race in KDRI, the geographical limit in the Lung Allocation Score, and the inadequacy of risk stratification in the Heart Tier system, creating obstacles for medically underserved populations.

Conclusions: We encourage efforts to address statistical and ethical concerns in organ allocation models and urge standardization and transparency in policy development to ensure fairness, equitability, and evidence-based risk predictions.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
不一致的价值观和算法公平性:美国器官分配优先权制度回顾。
背景:器官获取与移植网络(OPTN)最终规则指导着国家器官移植政策,规定了公平的器官分配和特定器官优先分层系统。目前的分配评分依赖于死亡率预测:我们研究了器官优先级系统的伦理优先级与相关风险模型的统计设计之间的一致性。我们在 PubMed 上检索了有关美国器官分配历史、政策和伦理的文献:我们发现了 127 篇相关文章,涉及肾移植(19 篇)、肝移植(60 篇)、肺移植(24 篇)、心脏移植(23 篇)以及移植的可及性(1 篇)。目前的风险评分强调模型性能,忽视了变量选择中的伦理问题。将种族、性别和地域限制纳入分类变量缺乏生物学依据,因此模糊了循证模型与歧视之间的界限。对风险评分缺乏全面的伦理和公平评估,一些文献仅对终末期肝病模型(MELD)和肾脏捐献者风险指数(KDRI)的算法公平性进行了有限的讨论。我们揭示了美国器官分配评分所依据的不一致的伦理标准。具体而言,我们强调了 MELD 中的例外点、KDRI 中的种族纳入、肺分配评分中的地域限制以及心脏分级系统中风险分层的不足,这些都为医疗服务不足的人群造成了障碍:我们鼓励努力解决器官分配模型中的统计和伦理问题,并敦促在制定政策时实现标准化和透明化,以确保公平、公正和基于证据的风险预测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
BMC Medical Ethics
BMC Medical Ethics MEDICAL ETHICS-
CiteScore
5.20
自引率
7.40%
发文量
108
审稿时长
>12 weeks
期刊介绍: BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
期刊最新文献
Public perceptions of the Hippocratic Oath in the U.K. 2023. Ethical challenges in organ transplantation for Syrian refugees in Türkiye. What ethical conflicts do internists in Spain, México and Argentina encounter? An international cross-sectional observational study based on a self-administrated survey. Medical futility at the end of life: the first qualitative study of ethical decision-making methods among Turkish doctors. Financial conflicts of interest among authors of clinical practice guideline for headache disorders in Japan.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1