Stakeholder governance of organ transplantation: A desirable model for inducing evidence-based medicine?

Medical governance should secure and apply appropriate expertise, accommodate stakeholder interests, and promote social values. The most common form of governance, public (agency) rulemaking by government agencies, usually involves supplementing in-house expertise through advisory committees. An alternative, private (stakeholder) rulemaking, involves delegating the authority for developing rules directly to stakeholders, who often command relevant expertise, including that arising out of tacit knowledge. The possible advantages and disadvantages of agency and stakeholder rulemaking in medical governance can be assessed both from what we know about these forms in general and from experience with a prominent example of stakeholder rulemaking; that is, governance of the US organ transplantation system. It appears that this governance has been exceptionally successful in promoting evidence-based medicine. The stakeholder role in the governance of transplantation could be replicated in other areas by creating meaningful stakes to engage stakeholders and by increasing isolation from legislative politics through an independent funding source and circumscribed oversight.