Abstract
BackgroundDeceased donor kidneys are a scarce health resource, yet patient preferences for organ allocation are largely unknown. The aim of this study was to determine patient preferences for how kidneys should be allocated for transplantation.MethodsPatients on dialysis and kidney transplant recipients were purposively selected from two centres in Australia to participate in nominal/focus groups in March 2011. Participants identified and ranked criteria they considered important for deceased donor kidney allocation. Transcripts were thematically analysed to identify reasons for their rankings.ResultsFrom six groups involving 37 participants, 23 criteria emerged. Most agreed that matching, wait-list time, medical urgency, likelihood of surviving surgery, age, comorbidities, duration of illness, quality of life, number of organs needed and impact on the recipient's life circumstances were important considerations. Underpinning their rankings were four main themes: enhancing life, medical priority, recipient valuation, and deservingness. These were predominantly expressed as achieving equity for all patients, or priority for specific sub-groups of potential recipients regarded as more "deserving".ConclusionsPatients believed any wait-listed individual who would gain life expectancy and quality of life compared with dialysis should have access to transplantation. Equity of access to transplantation for all patients and justice for those who would look after their transplant were considered important. A utilitarian rationale based on maximizing health gains from the allocation of a scarce resource to avoid "wastage," were rarely expressed. Organ allocation organisations need to seek input from patients who can articulate preferences for allocation and advocate for equity and justice in organ allocation.
Highlights
Deceased donor kidneys are a scarce health resource, yet patient preferences for organ allocation are largely unknown
Deceased donor organ allocation algorithms are developed with little direct input of patient values and are based on a combination of the following criteria: waiting time, medical urgency, human leukocyte antigen (HLA) matching, sensitization and paediatric status [6]
Some of these preferences reflect current organ allocation algorithms which are based on time on waiting list, medical urgency, human leukocyte antigen (HLA) matching, sensitization and paediatric status [6]
Summary
Deceased donor kidneys are a scarce health resource, yet patient preferences for organ allocation are largely unknown. Deceased donor organ allocation algorithms are developed with little direct input of patient values and are based on a combination of the following criteria: waiting time, medical urgency, human leukocyte antigen (HLA) matching, sensitization and paediatric status [6]. This lack of patient input into transplantation policy, combined with a lack of evidence around the nature of patient preferences, has added potentially unnecessary controversy to the formulation of policy in this area [7,8,9,10]. This seeks to maximize graft survival but it limits the overall transplant opportunities for older and sicker patients, and may not lead to maximising incremental health gains
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
