Refusal to participate in research. 3. Decisions regarding eligibility and allocation will take into account the following ethically relevant factors: • Relative urgency of need • Medical factors which affect likelihood of success (e.g. comorbidities, tissue matching) • Relative severity of illness and disability • Relative length of time on the waiting list • Likelihood that the recipient will be able to comply with the necessary ongoing treatment after transplantation. April 2021 version 1.5 vii To be eligible to be wait-listed for organ transplantation, patients must be referred for assessment and meet the relevant eligibility criteria as specified in this document. The transplant assessment process requires referred patients to be evaluated by a transplant unit; this evaluation process takes into consideration patients’ medical history and other relevant factors. Once listed, patients are regularly reviewed to ensure that they remain eligible to receive a transplant. Organ allocation processes vary according to the organ that is to be transplanted. Allocation of hearts, lungs, livers, and intestines involves transplant units making a clinical judgement when an organ becomes available as to which patient on the waiting list has the greatest need of that particular organ, at that particular time, based on a range of factors. Patients who require kidney or pancreas transplantation are generally stable over a prolonged period of time, and the allocation of these organs is currently based primarily on the closeness of tissue matching and the time spent on dialysis or on the transplant waiting list. The criteria used to decide which patients are placed on a transplant waiting list and how deceased donor organs are allocated do not determine how many patients will be transplanted, but rather which patients are eligible to receive which donor organs. It is recognised that whatever process is used, there will still be many patients who might benefit from an organ transplant but will not be able to receive one because of the limited supply of organs. The criteria and processes outlined in this document seek to achieve an appropriate balance between the needs of individuals with end-stage organ failure and the obligation of transplant teams to exercise responsible stewardship of the community’s healthcare resources, including donated organs. References 1. Ethical Guidelines for Organ Transplantation from Deceased Donors. Australian Government National Health and Medical Research Council, Canberra, 2016. Part A General issues related to recipient eligibility and donor assessment April 2021 version 1.5 1 1 Recipient Eligibility The relative scarcity of donor organs means that transparent eligibility criteria are required to ensure a just and equitable system for deciding which patients will have access to organ transplantation as a therapy. Determining eligibility in an environment where need exceeds availability involves balancing the potentially conflicting ethical principles of equity and utility. Equity, in its purest form, requires that every potential recipient who might benefit from an organ transplant has an equal opportunity to receive one. Utility, on the other hand, requires that the community should derive the maximum possible benefit from the limited number of organs available for transplantation. The eligibility criteria and allocation processes outlined in this document attempt to balance these ethical principles in a practical and transparent manner. It should be noted, however, that because the allocation of organs is a complex process with a range of factors informing the decision to offer a particular organ to a particular recipient, wait-listed patients will wait for variable periods of time regardless of their relative medical need. 1.1 Referral Patients are referred to transplant units by their treating specialist physician for assessment of their eligibility to be entered onto a transplant waiting list. Eligibility is determined on the basis of organ-specific criteria that have been developed by the relevant Advisory Committee or Working Group of the Transplantation Society of Australia and New Zealand. Comprehensive, multidisciplinary assessment of potential candidates for transplantation is a complex and time-consuming process. It is important that referral is timely to enable suitable patients to be listed as early as is medically appropriate. In some cases—particularly in the case of kidney transplantation where the patient is not at immediate risk of death—it would usually be appropriate to optimise the patient’s medical, social and psychological situation prior to referral and evaluation for wait-listing. 1.2 Assessment for eligibility 1.2.1 General inclusion and exclusion criteria The assessment process typically requires that patients undergo a standard set of consultations and investigations to evaluate their suitability for organ transplantation. Some patients will require further investigations depending on their specific circumstances. Clinical assessment should involve evaluation by a multidisciplinary transplant team that includes (as a minimum) both a suitably experienced transplant surgeon and a suitably experienced transplant physician (see Section 1.4). The transplant team should regularly review wait-listed patients to ensure that they remain suitable for transplantation. Listed patients should be removed from the transplant