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Allocation of Places for Patients to Receive Dialysis in Low and Middle Income Countries: An Ethical Framework for Distributive Justice

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Access to dialysis and kidney transplantation is limited in low and middle income countries, therefore rationing of dialysis services is usually necessary. Structured rationing systems however are often not in place and even when used may result in ethically irrelevant factors determining who gets dialysis. In this paper I propose a dialysis allocation system, based on a modification of the complete lives system, incorporating the following ethical principles: (1) prognosis (saving the most life-years), (2) saving the most lives, (3) age prioritization (for younger patients) and (4) random selection weighted by waiting time. Application of these principles should result in fair and equitable access to dialysis. 

11 Jan, 2017
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e-Published: 13 Jan, 2017


Manuscripts that are Published Ahead of Print have been peer reviewed and accepted for publication by the Editorial Board of the West Indian Medical Journal. They may appear in their original format and may not be copy edited or formatted in the style guide of this Journal. While accepted manuscripts are not yet assigned a volume, issue or page numbers, they can be cited using the DOI and date of e-publication. See our Instructions for Authors on how to properly cite manuscripts at this stage. The contents of the manuscript may change before it is published in its final form. Manuscripts in this section will be removed once they have been issued to a volume and issue, but will still retain the DOI and date of e-publication.

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