Abstract
BackgroundThere is a stark disparity between the number of patients awaiting deceased-donor organ transplants and the rate at which organs become available. Though organs for transplantation are assumed to be a community resource, and the organ supply depends on public willingness to donate, current allocation schemes do not explicitly incorporate public priorities and preferences. This paper seeks to provide insights regarding the Israeli public’s preferences regarding criteria for organ (specifically, kidney) allocation, and to determine whether these preferences are in line with current allocation policies.MethodsA market research company administered a telephone survey to 604 adult participants representing the Jewish-Israeli public (age range: 18–95; 50% male). The questionnaire comprised 39 questions addressing participants’ knowledge, attitudes, and preferences regarding organ donation and criteria for organ allocation, including willingness to donate.ResultsThe criteria that respondents marked as most important in prioritizing waitlist candidates were maximum medical benefit (51.3% of respondents) and waiting time (21%). Donor status (i.e., whether the candidate is registered as an organ donor) was ranked by 43% as the least significant criterion. Most participants expressed willingness to donate the organs of a deceased relative; notably, they indicated that they would be significantly more willing to donate if organ allocation policies took their preferences regarding allocation criteria into account. Unlike individuals in other countries (e.g., the UK, the US, and Australia) who responded to similar surveys, Israeli survey respondents did not assign high importance to the candidate’s age (24% ranked it as the least important factor). Interestingly, in some cases, participants’ declared preferences regarding the importance of various allocation criteria diverged from their actual choices in hypothetical organ allocation scenarios.ConclusionsThe findings of this survey indicate that Israel’s citizens are willing to take part in decisions about organ allocation. Respondents did not seem to have a strict definition or concept of what they deem to be just; yet, in general, their preferences are compatible with current policy. Importantly, participants noted that they would be more willing to donate organs if their preferences were integrated into the allocation policy. Accordingly, we propose that allocation systems must strive to respect community values and perceptions while maintaining continued clinical effectiveness.
Highlights
IntroductionThere is a stark disparity between the number of patients awaiting deceased-donor organ transplants and the rate at which organs become available (for example, Fig. 1 portrays the organ shortage in the United States, whereas Table 1 depicts the number of waiting list candidates for each organ in Israel)
Organs for transplantation are a scarce resource
The current study focuses on an element that remains noticeably absent from this debate and from the allocation decisions made in practice: namely, public perceptions and opinions regarding organ allocation criteria
Summary
There is a stark disparity between the number of patients awaiting deceased-donor organ transplants and the rate at which organs become available (for example, Fig. 1 portrays the organ shortage in the United States, whereas Table 1 depicts the number of waiting list candidates for each organ in Israel). Recent reports by the US Organ Procurement and Transplantation Network (OPTN) indicate that 95% of US adults support organ donation, yet only 54% are registered as donors [3]. 14% (944,849) of adults have signed an organ donor card [6]. There is a stark disparity between the number of patients awaiting deceased-donor organ transplants and the rate at which organs become available. This paper seeks to provide insights regarding the Israeli public’s preferences regarding criteria for organ (kidney) allocation, and to determine whether these preferences are in line with current allocation policies
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