An AI ethics board is reviewing a proposed AI system that allocates organ transplant priority scores. Which ethical principle creates the MOST tension when designing this system?

Here's the deal — a is correct because organ allocation AI creates a fundamental ethical tension between utilitarian efficiency (maximizing the number of successful transplants or life-years saved) and equity (ensuring all patient groups have fair access regardless of social determinants of health) — a classic AI ethics dilemma in high-stakes domains. B, C, and D are real tensions but are not as morally fundamental in the organ allocation context.