Triage Protocol Design for Ventilator Rationing in a Pandemic: Integrating Multiple Ethical Values through Reserves

Reserve Systems for Allocation of Scarce Medical Resources During the COVID-19 Pandemic

“…7,8 Anticipating similar challenges for COVID-19 pandemic resource allocation, we further developed reserve systems to accommodate multiple ethical values. 9 In a reserve system tailored for pandemic resource allocation, a portion of resources can be reserved for essential personnel, and a portion can be made available to other patients. This provides a method to sidestep the concern that essential personnel exhaust all resources.…”

A Reserve System for the Equitable Allocation of a Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine

“…In this system, total vaccine supply would be partitioned among a number of reserve categories, and a different ethical principle would guide allocation in each category. First described by Pathak et al, 4 reserve systems offer needed flexibility by allowing competing ethical principles to act within the same framework. A fair allocation system for vaccine allocation must be structured so that all who are interested have some chance of receiving a vaccine, while also promoting justice for disadvantaged groups and reciprocity for those who support vaccine development.…”

Improving Ventilator Rationing Through Collaboration With Experts on Resource Allocation

“…In our study of ventilator rationing guidelines, 2 we have not seen task forces include input from experts on market design, a field of economics that studies the allocation of scarce resources. In many settings, price plays a central role in allocation when demand exceeds supply; however, this instrument is often not available in public health emergencies with extreme scarcity.…”

“…This flexibility helps to achieve a balance between different stakeholders without needing to completely reject certain principles. Our study 2 provides examples for debates on prioritizing essential personnel or protecting the rights of patient groups with disadvantage or disability. Reserve systems are used in other settings when there is no consensus on which principles should guide allocation.…”