ORGAN ALLOCATION AND PROCUREMENT: Edited by Raymond J. LynchOrgan allocation in the age of the algorithm avoiding futile transplantation – utility in allocationFaitot, Francoisa,b; Michard, Baptistea; Artzner, Thierrya,cAuthor Information aHepatobiliopancreatic Surgery and Transplantation Department, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg bLaboratoire ICube, UMR7357, University of Strasbourg cIntensive Medecine Department, Hopital de Hautepierre, Hopitaux Universitaires de Strasbourg, Strasbourg, France Correspondence to Francois Faitot, Hepatobiliopancreatic Surgery and Transplantation Department, Hopitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1, Avenue Molière, 67000 Strasbourg, France. Tel: +33388127285; fax: +33388127286; e-mail: firstname.lastname@example.org Current Opinion in Organ Transplantation: June 2020 - Volume 25 - Issue 3 - p 305-309 doi: 10.1097/MOT.0000000000000752 Buy Metrics Abstract Purpose of review This review describes and questions the evolution of allocation systems from local team decisions in the 20th century to patient-oriented allocation using complex algorithm predicting transplant benefit. Recent findings The opening years of the 2000s have seen the implementation of prioritization scores aiming at increasing transparency and reducing waitlist mortality. The 2010s have underlined the necessity of drawing the upper limits of how sick a patient can be while still ensuring acceptable survival. More complex algorithms evaluating transplant benefit have been implemented in allocation systems to take this issue into account. Summary Allocation algorithms are becoming more and more complex, integrating numerous parameters from both donor and recipient to achieve optimal matching. The limitations of implementing these complex algorithms are represented by the evermoving waiting list demography, geographic disparities between recipients and donors, team policy adaptation to rule changes, and implicit biases within the transplant community. Survival as the only metric by which to define benefit may be seen as restrictive; quality of life may be a fruitful measure for better defining benefit in organ transplantation in the future. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.