Should Individuals Receive Organ Transplants Based on Qualification?

What about children?  Maybe the more important question should be, who should be in charge of deciding who gets an organ?

On one hand, there seems to be some pretty specific rules for organ allocation. as defined by the U.S. Department of Health and Human Services.  These are elaborate rules having to do mostly with organ affinity—e.g., blood-type compatibility—and are very clear and unambiguous.

On the other hand, the following sentences preface the aforementioned rules:

The final decision to accept a particular organ will remain the prerogative of the transplant surgeon and/or physician responsible for the care of the candidate. This allows physicians and surgeons to exercise their medical judgment regarding the suitability of the organ being offered for a specific candidate; to be faithful to their personal and programmatic philosophy about such controversial matters as the importance of cold ischemia time and anatomic anomalies; and to give their best assessment of the prospective recipient's medical condition at the moment. — First paragraph of policy 3.5 of the Organ Procurement and Transplantation Network.

In other words, from the pool of compatible recipients, it's the doctors get to decide who gets the organ.

It stands to reason that some lives might be more worth saving than others; for example, a patient with terminal cancer should not receive a kidney that could have gone to someone with better expectations.  But it doesn't seem kosher to me that a "group of experts" gets to decide who gets these organs.  The rules should be clearly written and followed whenever possible.  They should include valid corner cases that could affect the outcome, such as likelihood of survival due to other causes (such as preexisting conditions).  But doctors should not be allowed to use their own personal judgement to decide who gets an organ, unless absolutely unavoidable.

On the topic at hand, the case of Amelia Rivera, to use mental retardation as cause to deny a patient an organ smacks of eugenics or worse.  Hopefully that was never the issue here.