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

Abstract

Objective: To investigate the nature of public preferences in the allocation of donor liver grafts for transplantation. Design: A qualitative study based upon the transcripts of four focus groups. Setting: Derby, Derbyshire, UK. Participants: Twenty-two members of the public in the Derby locality, recruited to one of four focus groups through local community groups. Main Outcome Measures: The views of focus group members as to the importance (or otherwise) of several potential discriminating factors which could be used in the prioritization of patients on the waiting list for liver transplantation were ascertained. The factors included were expected posttransplantation prognosis, the age of the patient, whether the patient was personally responsible for their illness, the time spent on the waiting list, re-transplantation or primary transplant and the social background of the patient. CommentsBecause of a critical and persistent donor liver shortage, priorities for receipt of donor organs need to be set. 1 However, there is serious disagreement among medical practitioners, researchers, and policy-makers concerning the allocation principles to be used. Interest in studying what the public thinks regarding the allocation of scarce resources such as donor livers for transplantation is thus growing. 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. The critical question at this juncture concerns its use. What role can (or should) information on societal values play in the setting of public priorities? As a recent UK-based study shows, the link is far from straightforward.Wilmot and Ratcliffe 8 investigated public attitudes toward several factors that could be used to prioritize patients waiting for liver transplantation in the UK. They reported transcribed responses of 22 participants recruited into one of four focus groups in Derbyshire, UK. Participants were asked to respond to a hypothetical case study containing written descriptions of the characteristics of five individuals waiting for a liver transplant. Each individual was described to represent one of five potential discriminating criteria: the importance of consequences (medical prognosis), moral desert (whether the patient could be considered personally responsible for their illness, for example, through alcoholic liver disease), two criteria reflecting fair process (length of time on the waiting list, initial transplantation or retransplantation), and patient age. In the initial exercise, the groups were told that one donor liver was available, and that it was compatible with any of the five individuals described. Moreov...

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Scopes, Options, and Horizons – Key Issues in Decision Structuring

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