Ethical Challenges in Physician Advocacy and Organ Allocation Policies: Analysis of Exception Letters for Heart Transplantation

The U.S. heart allocation policy changed in 2018 and significantly changed transplant programs’ practices. The use of exception requests for listing patients at the highest urgency statuses accelerated under the new system. These requests are almost universally approved and can serve as loopholes. Exceptions raise concerns about gaming and institutional/regional variability that threaten fair allocation. Dr. Khazanie’s project will utilize a uniquely available dataset to aim to: (1) understand current practices regarding exceptions, (2) identify key ethical concerns, and (3) develop policy recommendations.