Entrusting a vital decision to a machine

Since 2018, an algorithm developed by the national biomedical agency has been setting the order of proposals for heart transplants, a vital resource of which the available quantities do not suffice to meet the needs. Even though it deprives them of part of their professional autonomy, doctors generally accept this centralized and automatic system. The allocation seems imperfect, yet it is deemed to be preferable to human allocation, which was largely manipulated by the transplant centres. Field research has revealed new practices in the transplant centres that appropriate the functioning of the algorithm in order to implement strategies to minimize its impact and to participate in discussions on the evolution of the automatic system.