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.
@article{fb0682a125ea4c55aba051adc4768060,
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. ",
keywords = "adult, age distribution, aged, Article, community care, controlled study, female, graft survival, hospital admission, human, life expectancy, major clinical study, male, needs assessment, organ donor, organ transplantation, patient selection, place preference, postoperative period, prediction, priority journal, quality of life, social behavior, very elderly, young adult",
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",
year = "2015",
doi = "10.1097/TP.0000000000000365",
language = "English",
volume = "99",
pages = "560--567",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams & Wilkins",
number = "3",

}

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

TY - JOUR

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

AU - Wong, Germaine

AU - Irving, Michelle

AU - Tong, Allison

AU - Craig, Jonathan

AU - Chadban, Steve

AU - Allen, Richard

AU - Cass, Alan

PY - 2015

Y1 - 2015

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. 

KW - adult

KW - age distribution

KW - aged

KW - Article

KW - community care

KW - controlled study

KW - female

KW - graft survival

KW - hospital admission

KW - human

KW - life expectancy

KW - major clinical study

KW - male

KW - needs assessment

KW - organ donor

KW - organ transplantation

KW - patient selection

KW - place preference

KW - postoperative period

KW - prediction

KW - priority journal

KW - quality of life

KW - social behavior

KW - very elderly

KW - young adult

U2 - 10.1097/TP.0000000000000365

DO - 10.1097/TP.0000000000000365

M3 - Article

VL - 99

SP - 560

EP - 567

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 3

ER -