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Predictions of patient behaviour can also be used\u2014for example, patients on the liver transplant waiting list could receive lower priority based on a high likelihood of non\u2010adherence to their immunosuppressant medication regimen or of drinking excessively. But is this ethically acceptable? In this paper, we will explore arguments for and against behavioural predictions, before providing novel empirical evidence on this question. Firstly, we note that including behavioural predictions would lead to improved transplant outcomes. Fairness could also require prioritising those predicted to engage in healthier behaviours: consistent with using behavioural predictions in other contexts such as psychiatry and substance misuse. Conversely, behavioural predictions may be judged too inaccurate or discriminatory, or it may be thought unfair to deprioritise based on future behaviour. In part two, we performed an online survey of 172 UK adults. When presented with possible factors relevant to liver allocation, most thought predictions of higher medication adherence (78.6%) and lower future alcohol use (76.5%) should be used but not predictions of lower future criminality (24.7%) and higher societal contribution (21.2%). Randomising participants into two groups, 69.8% of participants found deprioritising a patient based on their predicted medication adherence acceptable (91.9% found a nonbehavioural prediction acceptable). We did not identify an ethically relevant difference between behavioural predictions and other medical predictions already used in organ allocation. Our sample of participants also appeared to support behavioural predictions in this context.<\/jats:p>","DOI":"10.1111\/bioe.13440","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T01:55:11Z","timestamp":1751248511000},"page":"737-747","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Should We Use Behavioural Predictions in Organ Allocation?"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5159-0379","authenticated-orcid":false,"given":"Max","family":"Drezga\u2010Kleiminger","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia"},{"name":"Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3958-8633","authenticated-orcid":false,"given":"Dominic","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy University of Oxford Oxford UK"},{"name":"Centre for Biomedical Ethics, Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore"},{"name":"John Radcliffe Hospital Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6788-3608","authenticated-orcid":false,"given":"Thomas","family":"Douglas","sequence":"additional","affiliation":[{"name":"Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2428-7301","authenticated-orcid":false,"given":"Joanna","family":"Demaree\u2010Cotton","sequence":"additional","affiliation":[{"name":"Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2752-7334","authenticated-orcid":false,"given":"Julian","family":"Koplin","sequence":"additional","affiliation":[{"name":"Monash Bioethics Centre Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1691-6403","authenticated-orcid":false,"given":"Julian","family":"Savulescu","sequence":"additional","affiliation":[{"name":"Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy University of Oxford Oxford UK"},{"name":"Centre for Biomedical Ethics, Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore"},{"name":"Murdoch Children's Research Institute Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13710"},{"key":"e_1_2_9_3_1","unstructured":"\u201cDeceased Donor Liver Distribution and Allocation \u201d NHS Blood and Transplant 2014 https:\/\/www.odt.nhs.uk\/transplantation\/tools-policies-and-guidance\/policies-and-guidance\/."},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2019.10.019"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/jme-2022-108630"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.22210"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/14999013.2014.922141"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/jme-2023-109094"},{"key":"e_1_2_9_9_1","unstructured":"\u201cLiver Transplantation: Selection Criteria and Recipient Registration \u201d NHS Blood and Transplant 2024 https:\/\/www.odt.nhs.uk\/transplantation\/tools-policies-and-guidance\/policies-and-guidance\/."},{"key":"e_1_2_9_10_1","unstructured":"\u201cClinical Guidelines for Organ Transplantation From Deceased Donors \u201d The Transplantation Society of Australia and New Zealand 2021 https:\/\/tsanz.com.au\/guidelinesethics-documents\/organallocationguidelines.htm."},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/bioe.12869"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/175114371301400"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1037\/law0000219"},{"key":"e_1_2_9_14_1","unstructured":"J.Angwin J.Larson S.Mattu andL.Kirchner \u201cProPublica \u201d2016 https:\/\/www.propublica.org\/article\/machine-bias-risk-assessments-in-criminal-sentencing."},{"key":"e_1_2_9_15_1","unstructured":"A. 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