There is no neutral queue#
SLOP2710 · Week 12 · Adaeze and Priya
More people need a kidney than there are kidneys#
No process improvement fixes that.
Every organ gets used. There is no efficiency left to extract.
The only question is order.#
Every rule you learned has been proposed for it#
Arrival order — transparent, ungameable, wastes organs
Most life-years — maximises the good, deprioritises the old and the sick
Sickest first — medical instinct, least efficient rule available
Price — illegal almost everywhere, and the objection is not efficiency
So which one did the US pick?#
- life-years an organ
- —
- W on the list
- —
- slowest tenth waited over
- —
- organs to the over-60s
- —
- died on the list
- —
The readout is the matrix, live#
| rule | life-yrs | W | slowest tenth | to 60+ | died |
|---|---|---|---|---|---|
| longest wait | 9.7 | 2.7 yr | 4.8 yr | 43% | 35% |
| most life-years | 12.6 | 2.2 yr | 6.0 yr | 24% | 36% |
| sickest first | 9.0 | 3.7 yr | 12.0 yr | 44% | 35% |
| highest bidder | 9.7 | 2.6 yr | 7.8 yr | 44% | 38% |
| points | 11.1 | 2.9 yr | 5.5 yr | 33% | 38% |
Over-sixties: 42% of the list#
under arrival order.#
83% under most-life-years.#
And the last column barely moves#
35 to 38 per cent leave without an organ under every rule.
Ordering is conservative. Week 8’s theorem, with the stakes changed.
The only control in the room
that changes how many people die
is the supply.
What the real system actually does#
- waiting time — now backdated to the start of dialysis
- sensitisation — steep points for the hardest to match
- paediatric status, prior living donors
- longevity matching — best fifth of organs to best fifth of candidates
- 2021 — regional boundaries replaced by distance circles
Places society had to publish the rule#
Vaccine prioritisation, 2020–21 — the largest triage exercise ever conducted in public
ICU protocols in a pandemic — written in advance, so they could be argued with
School lotteries · social housing points
The café. The express lane. The hold message. The boarding zones.#
Not one of them is written where the queue can read it.#
A system that has not chosen#
has not escaped the choice#
The method, in five words#
observe · model · experiment · cost · decide
— and then say out loud what you decided.
What you can do now that you could not in February#
Watch a line for ninety seconds and state the rule.
Measure it from outside with a stopwatch.
Put a number on what it costs, and name who holds the bill.
Propose a different rule and predict who wins and who loses.