Allocation of transplantable organs: Do people want to punish patients for causing their illness?

Abstract

Some people believe patients with alcoholic cirrhosis should not receive equal priority for scarce transplantable organs. This may reflect a belief that these patients (1) are personally responsible for causing their own illnesses, (2) have poor transplant prognoses, or (3) are unworthy because they have engaged in socially undesirable behavior. We explore the roles that social desirability and personal responsibility have in people's judgments about transplant allocation. We presented prospective jurors with 4 scenarios, asking them to distribute 100 transplantable organs among 2 groups of 100 patients each. In each scenario, 1 group of patients, but not the other, was described as having a history of unhealthy behavior (alcohol or cigarette use) associated with a poorer prognosis. In some scenarios, alcohol or cigarette use was said to cause the organ failure. In others, it only contributed to the patients' transplant prognosis. We also obtained self-reports of subjects' own smoking status. Subjects allocated significantly fewer than half the organs to those with unhealthy behaviors and worse prognoses (33%; P < .001), but the specific behavior (alcohol versus cigarette use) was not significantly associated with subjects' allocation choices. Significantly fewer organs were allocated to patients with behavior responsible for causing their diseases than to other patients (P < .0001). Subjects who never smoked discriminated the most and current smokers discriminated the least against patients with a history of unhealthy behavior (P < .0001). The public's transplantation allocation preferences are influenced by whether patients' behaviors are said to have caused their organ failure. (Liver Transpl 2001;7:600-607.)

QALY maximisation and people's preferences: a methodological review of the literature

“…Ubel and colleagues note that in response to these questions respondents who had never smoked discriminated the most, and those who were current smokers discriminated the least [53]. Furnham and colleagues found that, in individual interviews followed by focus group discussions, respondents generally favoured non-smokers [54].…”

Solid-Organ Transplantation in HIV-Infected Patients

“…Such associations, however, have never been a legitimate reason to withhold medical interventions from patients. 55,56 HCV is also commonly acquired through intravenous-drug use, and hepatitis B virus (HBV) is also commonly acquired through the same high-risk sexual practices as those associated with the transmission of HIV. Yet these diseases, along with alcoholic liver disease, remain the most common indications for liver transplantation in the United States.…”

Setting organ allocation priorities: Should we care what the public cares about?

“…Such research offers a potentially fruitful avenue for deciding among potential allocation principles. Studies to date have shown that, all things equal, the public prefers that lifesaving procedures such as transplantations be given to the young over the old, 2-4 to those not responsible for their illness over those whose illness is self-inflicted, 5,6 and to primary transplantation candidates over retransplantation candidates. 7 Much information of this sort has been gathered.…”