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

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: (a) prognosis (saving the most life-years), (b) saving the most lives, (c) age prioritization (for younger patients) and (d) random selection weighted by waiting time. The application of these principles should result in fair and equitable access to dialysis.