Table 1.

Ethical principles supporting pediatric prioritization in deceased donor kidney allocation.

Bioethics principle	Rationale for pediatric prioritization
Beneficence	• Better survival, QoL, lower morbidity than dialysis • Opportunity to grow, and overcome the physical and neurocognitive disabilities unique to pediatric CKD
Justice	• Children deserve a “fair innings” at enjoying medical well-being as they grow, as all individuals deserve the opportunity to live through each life-stage
Utility	• Children have less comorbidities and are expected to survive longer than an older adults with kidney failure
Equity	• Prioritizing children balances the advantage that adults have over children in terms of waitlisted time • Recognizes that children do not bear responsibility for organ failure and are an inherently vulnerable group
Non-maleficence	• Rarity of pediatric kidney failure ensures that a very small number of kidneys get diverted away from waitlisted adults

QoL, quality of life; CKD, chronic kidney disease.