Community preferences for the allocation of donor organs for transplantation: A discrete choice study

Abstract

Background Demand for organs for transplant exceeds supply. There is an ongoing debate about the relative weighting that should be given to different allocation criteria. Little is known about the relative weight the community places on various allocation criteria. This study aims to determine community preferences for organ allocation. Methods Community respondents recruited from a web-based panel chose which patient received a transplant in 30 scenarios presenting two hypothetical patients. Patients were described in age, sex, previous transplants, whether they or family were registered donors, had caring responsibilities, adherence, time on waiting list, estimated survival and quality of life (QOL) with and without transplant, comorbidities, and lifestyle factors, such as smoking. Analyses were conducted in NLOGIT 5.0, using a mixed-logit model. Results Two thousand fifty-one respondents aged 18 to 83 years completed the survey. All attributes significantly influenced recipient choice except sex and having diabetes. Younger patients were preferred over older patients. Family member donor registration, having caring responsibilities, and longer time on waiting list increased priority. Pretransplant life expectancy was valued more highly than posttransplant life expectancy; 1 year less of pretransplant life expectancy required an increase of 1.49 years in posttransplant life expectancy to compensate. Posttransplant QOL was valued more highly than pretransplant QOL. Conclusion Lower pretransplant life expectancy (need) was more important than higher posttransplant life expectancy (utility). Although current allocation algorithms are consistent with community preferences for prioritizing children and time on the waiting list, favoring patients with high predicted posttransplant survival as potential recipients may not be aligned with community preferences.