Systematic Review of Public Preferences for the Allocation of Donor Organs for Transplantation: Principles of Distributive Justice

Abstract

Background Solid organ transplantation is the treatment of choice for organ failure, but donor organs are a scarce resource because of a large mismatch between supply and demand. This scarcity leads to an ethical dilemma, forcing priority setting in organ allocation to individual patients. Little is known about public preferences regarding priority setting in organ allocation. A systematic review was performed to review the existing evidence and provide an overview of the criteria and criterion levels in regard to ethical aspects of distributive justice. Methods The PubMed, Web of Science, EBSCO and PsycINFO databases were searched for literature published between January 2000 and December 2018. Only original studies were selected. The criteria were identified, extracted and grouped into a self-developed matrix according to the principles of distributive justice to ascertain public preferences. Results Overall, 9645 references were identified, and 15 studies were included. In total, 27 criteria clustered in seven theoryguided groups could be identified: "equality", "effectiveness/benefit", "medical urgency", "own fault", "value for society", "medical background" and "sociodemographic status". It was shown that not only a single principle but rather a combination of principles are relevant for the allocation. Therefore, a public propensity towards a rational utilitarian ethical model of allocation could be recognised. Conclusions The general public not only wanted to allocate organs mainly to those with a good probability of having a successful transplantation but also wanted to consider those who need an organ most urgently to prevent fatal consequences, resulting in unclear trade-offs between effectiveness/benefit and medical urgency. Public preferences for organ allocation are therefore complex, and data regarding clear trade-offs are still lacking.

Healthcare professional and community preferences in deceased donor kidney allocation: A best-worst scaling survey

“…In a review of qualitative and quantitative studies, Tong et al (2010) 7 identified seven themes describing community preferences including maximum benefit, social valuation, moral deservingness, prejudice, ‘fair innings’, ‘first come, first served’ and medical urgency. A more recent systematic review by Oedingen et al (2019) 8 applied a distributive justice framework. They found that while a rational utilitarian ethical model was preferred, this was contradicted by simultaneous priority to treat the most in need and concluded that “data on public preferences regarding clear trade‐offs in donor organ allocation are still lacking”.…”

The stigma of alcohol-related liver disease and its impact on healthcare

“…public preferences regarding organ donation indicate that perceptions of prognosis and individual need are most relevant, providing an opportunity to educate the public accordingly. 95,96 Finally, interventions to reduce the stigma associated with ALD and to facilitate early help-seeking need to be developed and evaluated. Interventions need to be tailored to relevant settings like primary and specialist healthcare, and relevant populations, like the general population or people with high-risk drinking behaviour.…”

Israeli Medical Experts’ Knowledge, Attitudes, and Preferences in Allocating Donor Organs for Transplantation

“…In another study, treatment adherence, life gains quality, and social productivity were substantially preferred for transparent and efficient allocating policy [ 23 ]. Further, patient advocacy, professional integrity, center reputation, social benefits [ 27 , 58 ], enforcement, relevance, appeal [ 43 ], medical background, sociodemographic status [ 59 ], and religious conviction [ 60 ] are the cluster of factors substantial for making an improved allocation system that attracts significant organ donors.…”