Community Preferences for the Allocation of Donor Organs for Transplantation

A Discrete Choice Study

Kirsten Howard, Stephen Jan, John Rose, Germaine Wong, Michelle Irving, Allison Tong, Jonathan Craig, Steve Chadban, Richard Allen, Alan Cass

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Demand for organs for transplant exceeds supply. There is an ongoing debate about the relative weighting that should be given to different allocation criteria. Little is known about the relative weight the community places on various allocation criteria. This study aims to determine community preferences for organ allocation. 
    Methods: Community respondents recruited from a web-based panel chose which patient received a transplant in 30 scenarios presenting two hypothetical patients. Patients were described in age, sex, previous transplants, whether they or family were registered donors, had caring responsibilities, adherence, time on waiting list, estimated survival and quality of life (QOL) with and without transplant, comorbidities, and lifestyle factors, such as smoking. Analyses were conducted in NLOGIT 5.0, using a mixed-logit model. 
    Results: Two thousand fifty-one respondents aged 18 to 83 years completed the survey. All attributes significantly influenced recipient choice except sex and having diabetes. Younger patients were preferred over older patients. Family member donor registration, having caring responsibilities, and longer time on waiting list increased priority. Pretransplant life expectancy was valued more highly than posttransplant life expectancy; 1 year less of pretransplant life expectancy required an increase of 1.49 years in posttransplant life expectancy to compensate. Posttransplant QOL was valued more highly than pretransplant QOL. 
    Conclusion: Lower pretransplant life expectancy (need) was more important than higher posttransplant life expectancy (utility). Although current allocation algorithms are consistent with community preferences for prioritizing children and time on the waiting list, favoring patients with high predicted posttransplant survival as potential recipients may not be aligned with community preferences. 
    Original languageEnglish
    Pages (from-to)560-567
    Number of pages8
    JournalTransplantation
    Volume99
    Issue number3
    DOIs
    Publication statusPublished - 2015

    Fingerprint

    Organ Transplantation
    Life Expectancy
    Tissue Donors
    Waiting Lists
    Transplants
    Quality of Life
    Survival
    Life Style
    Comorbidity
    Logistic Models
    Smoking
    Weights and Measures
    Surveys and Questionnaires

    Cite this

    Howard, Kirsten ; Jan, Stephen ; Rose, John ; Wong, Germaine ; Irving, Michelle ; Tong, Allison ; Craig, Jonathan ; Chadban, Steve ; Allen, Richard ; Cass, Alan. / Community Preferences for the Allocation of Donor Organs for Transplantation : A Discrete Choice Study. In: Transplantation. 2015 ; Vol. 99, No. 3. pp. 560-567.
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    title = "Community Preferences for the Allocation of Donor Organs for Transplantation: A Discrete Choice Study",
    abstract = "Background: Demand for organs for transplant exceeds supply. There is an ongoing debate about the relative weighting that should be given to different allocation criteria. Little is known about the relative weight the community places on various allocation criteria. This study aims to determine community preferences for organ allocation. Methods: Community respondents recruited from a web-based panel chose which patient received a transplant in 30 scenarios presenting two hypothetical patients. Patients were described in age, sex, previous transplants, whether they or family were registered donors, had caring responsibilities, adherence, time on waiting list, estimated survival and quality of life (QOL) with and without transplant, comorbidities, and lifestyle factors, such as smoking. Analyses were conducted in NLOGIT 5.0, using a mixed-logit model. Results: Two thousand fifty-one respondents aged 18 to 83 years completed the survey. All attributes significantly influenced recipient choice except sex and having diabetes. Younger patients were preferred over older patients. Family member donor registration, having caring responsibilities, and longer time on waiting list increased priority. Pretransplant life expectancy was valued more highly than posttransplant life expectancy; 1 year less of pretransplant life expectancy required an increase of 1.49 years in posttransplant life expectancy to compensate. Posttransplant QOL was valued more highly than pretransplant QOL. Conclusion: Lower pretransplant life expectancy (need) was more important than higher posttransplant life expectancy (utility). Although current allocation algorithms are consistent with community preferences for prioritizing children and time on the waiting list, favoring patients with high predicted posttransplant survival as potential recipients may not be aligned with community preferences. ",
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    author = "Kirsten Howard and Stephen Jan and John Rose and Germaine Wong and Michelle Irving and Allison Tong and Jonathan Craig and Steve Chadban and Richard Allen and Alan Cass",
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    Howard, K, Jan, S, Rose, J, Wong, G, Irving, M, Tong, A, Craig, J, Chadban, S, Allen, R & Cass, A 2015, 'Community Preferences for the Allocation of Donor Organs for Transplantation: A Discrete Choice Study', Transplantation, vol. 99, no. 3, pp. 560-567. https://doi.org/10.1097/TP.0000000000000365

    Community Preferences for the Allocation of Donor Organs for Transplantation : A Discrete Choice Study. / Howard, Kirsten; Jan, Stephen; Rose, John; Wong, Germaine; Irving, Michelle; Tong, Allison; Craig, Jonathan; Chadban, Steve; Allen, Richard; Cass, Alan.

    In: Transplantation, Vol. 99, No. 3, 2015, p. 560-567.

    Research output: Contribution to journalArticleResearchpeer-review

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    T1 - Community Preferences for the Allocation of Donor Organs for Transplantation

    T2 - A Discrete Choice Study

    AU - Howard, Kirsten

    AU - Jan, Stephen

    AU - Rose, John

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    AU - Irving, Michelle

    AU - Tong, Allison

    AU - Craig, Jonathan

    AU - Chadban, Steve

    AU - Allen, Richard

    AU - Cass, Alan

    PY - 2015

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    N2 - Background: Demand for organs for transplant exceeds supply. There is an ongoing debate about the relative weighting that should be given to different allocation criteria. Little is known about the relative weight the community places on various allocation criteria. This study aims to determine community preferences for organ allocation. Methods: Community respondents recruited from a web-based panel chose which patient received a transplant in 30 scenarios presenting two hypothetical patients. Patients were described in age, sex, previous transplants, whether they or family were registered donors, had caring responsibilities, adherence, time on waiting list, estimated survival and quality of life (QOL) with and without transplant, comorbidities, and lifestyle factors, such as smoking. Analyses were conducted in NLOGIT 5.0, using a mixed-logit model. Results: Two thousand fifty-one respondents aged 18 to 83 years completed the survey. All attributes significantly influenced recipient choice except sex and having diabetes. Younger patients were preferred over older patients. Family member donor registration, having caring responsibilities, and longer time on waiting list increased priority. Pretransplant life expectancy was valued more highly than posttransplant life expectancy; 1 year less of pretransplant life expectancy required an increase of 1.49 years in posttransplant life expectancy to compensate. Posttransplant QOL was valued more highly than pretransplant QOL. Conclusion: Lower pretransplant life expectancy (need) was more important than higher posttransplant life expectancy (utility). Although current allocation algorithms are consistent with community preferences for prioritizing children and time on the waiting list, favoring patients with high predicted posttransplant survival as potential recipients may not be aligned with community preferences. 

    AB - Background: Demand for organs for transplant exceeds supply. There is an ongoing debate about the relative weighting that should be given to different allocation criteria. Little is known about the relative weight the community places on various allocation criteria. This study aims to determine community preferences for organ allocation. Methods: Community respondents recruited from a web-based panel chose which patient received a transplant in 30 scenarios presenting two hypothetical patients. Patients were described in age, sex, previous transplants, whether they or family were registered donors, had caring responsibilities, adherence, time on waiting list, estimated survival and quality of life (QOL) with and without transplant, comorbidities, and lifestyle factors, such as smoking. Analyses were conducted in NLOGIT 5.0, using a mixed-logit model. Results: Two thousand fifty-one respondents aged 18 to 83 years completed the survey. All attributes significantly influenced recipient choice except sex and having diabetes. Younger patients were preferred over older patients. Family member donor registration, having caring responsibilities, and longer time on waiting list increased priority. Pretransplant life expectancy was valued more highly than posttransplant life expectancy; 1 year less of pretransplant life expectancy required an increase of 1.49 years in posttransplant life expectancy to compensate. Posttransplant QOL was valued more highly than pretransplant QOL. Conclusion: Lower pretransplant life expectancy (need) was more important than higher posttransplant life expectancy (utility). Although current allocation algorithms are consistent with community preferences for prioritizing children and time on the waiting list, favoring patients with high predicted posttransplant survival as potential recipients may not be aligned with community preferences. 

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    KW - organ donor

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