• Vaccine

Rationing and Allocating Scarce Medical Resources (January 2013)

Ezekiel J. Emanuel, M.D., Ph.D.

This course will explore the complex challenges of allocating scare medical resources at both the micro and macro level. Students will learn the theories behind allocation and use modern examples to explore how society makes the difficult decisions that arise when there is not enough to go around.

Who Should Get the Influenza Vaccine When Not All Can?

"The potential threat of pandemic influenza is staggering: 1.9 million deaths, 90 million people sick, and nearly 10 million people hospitalized, with almost 1.5 million requiring intensive-care units (ICUs) in the United States...Clear ethical justification for vaccine priorities is essential to the acceptability of the priority ranking and any modifications during the pandemic. With limited vaccine supply, uncertainty over who will be at highest risk of infection and complications, and questions about which historic pandemic experience is most applicable, society faces a fundamental ethical dilemma: Who should get the vaccine first?" [Emanuel & Wertheimer, Science 12 May 2006: Vol. 312 no. 5775 pp. 854-855

Organ Donors After Circulatory Determination of Death

Increased use of donors after circulatory determination of death (DCDD) has been advocated as the most viable method for increasing the supply of transplantable organs. However, the number of potential DCDD in the United States remains uncertain, with estimates accruing from retrospective single-center experiences in adult or pediatric hospitals. A research team that included Scott Halpern conducted a prospective, population-based cohort study to estimate the potential increase in the supply of deceased donors that might accrue from optimal use of controlled DCDD, donors in whom life-sustaining therapies are withdrawn and organs are recovered following the loss of spontaneous circulation.  [Halpern SD, Barnes B, Hasz, RD, Abt PL. Estimated supply of controlled donors after circulatory determination of death: a population-based cohort study. JAMA 2010; 304: 2592-4]

Principles for allocation of scarce medical interventions

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.  [Persad, Wertheimer, Emanuel, The Lancet, 373(9661): 423–431]

Regulated Payments for Living Kidney Donation: An Empirical Assessment of the Ethical Concerns

Scott Halpern has conducted empirical research on questions related to organ procurement.  "Theoretical concerns about paying persons for living kidney donation are not corroborated by empirical evidence. A real-world test of regulated payments for kidney donation is needed to definitively show whether payment provides a viable and ethical method to increase the supply of kidneys available for transplantation...In this study, we did not aim to assess the conceptual strengths and weaknesses of these concerns, but rather we used empirical methods to determine the extent to which these concerns might manifest if a regulated market for kidneys were established in the United States."  [Ann Intern Med. 2010 March 16; 152(6): 358–365.] | NPR Coverage