Table 3.

Proposed prognostic prioritization score

Specification0 Points1 Point2 Points3 Points4 Points (Patients in this Column would Already Be Triaged to Blue Group for Poor Prognosis, as Noted in Algorithm 1)
Predicted short-term survival (SOFA score)Not acutely ill, e.g., maintenance HD outpatientSOFA<6, e.g., inpatientSOFA=6–9, e.g., ICU patientSOFA=10–12, e.g., ICU patientSOFA>12, e.g., ICU patient
Predicted near-term survival (Charlson comorbidity index)Charlson Comorbidity Index 0, 1, or 2 pointsCharlson Comorbidity Index 3 or 4 pointsCharlson Comorbidity Index 5 or 6 pointsCharlson Comorbidity Index 7–9 pointsSevere comorbidities with death expected within 6 mo, e.g., Charlson Comorbidity Index ≥9
  • Patients are individually scored and ranked. Lower scores receive priority for KRT that day, according to capacity that day. The SOFA score is a mortality prediction score that is on the basis of the degree of dysfunction of six organ systems, and can be used to determine level of organ dysfunction and mortality risk in ICU patients (see https://qxmd.com/calculate/calculator_268/sequential-oron-failure-assessment-sofa). The Charlson Comorbidity Index is a mortality prediction score on the basis of the presence of 17 specific comorbidities and age, and has been validated in multiple studies involving kidney failure (https://www.mdcalc.com/charlson-comorbidity-index-cci). Tie-breaking principles: life cycle (the fair innings principle) followed by random allocation. Algorithm 1 and Table 4 operate on the principle of maximizing utility or maximizing benefit for the greatest number (saving the most lives and life years in terms of near-term survival). If further prioritization is required, then it is made on the basis of where individuals currently stand in the expected life cycle, with priority given to the worst-off individuals, defined as those who have had the least opportunity to experience life. This is the “fair innings principle” (equity/fairness). Individuals are ranked by age range (e.g., 12–40, 41–60, 61–75, and >75 years) roughly indicative of life stages, with priority given to those at an earlier life stage. If, after applying the life-cycle considerations tiebreaker, there are not enough resources to treat all patients within the lowest-ranked life-cycle group, then a lottery (i.e., random allocation) should be used to ultimately break the ties within that life-cycle group. SOFA, Sequential Organ Failure Assessment score; HD, hemodialysis; ICU, intensive care unit.