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Martínez-López MV, McLaughlin L, Molina-Pérez A, Pabisiak K, Primc N, Randhawa G, Rodríguez-Arias D, Suárez J, Wöhlke S, Delgado J. Mapping trust relationships in organ donation and transplantation: a conceptual model. BMC Med Ethics 2023; 24:93. [PMID: 37914997 PMCID: PMC10621073 DOI: 10.1186/s12910-023-00965-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/01/2023] [Indexed: 11/03/2023] Open
Abstract
The organ donation and transplantation (ODT) system heavily relies on the willingness of individuals to donate their organs. While it is widely believed that public trust plays a crucial role in shaping donation rates, the empirical support for this assumption remains limited. In order to bridge this knowledge gap, this article takes a foundational approach by elucidating the concept of trust within the context of ODT. By examining the stakeholders involved, identifying influential factors, and mapping the intricate trust relationships among trustors, trustees, and objects of trust, we aim to provide a comprehensive understanding of trust dynamics in ODT. We employ maps and graphs to illustrate the functioning of these trust relationships, enabling a visual representation of the complex interactions within the ODT system. Through this conceptual groundwork, we pave the way for future empirical research to investigate the link between trust and organ donation rates, informed by a clarified understanding of trust in ODT. This study can also provide valuable insights to inform interventions and policies aimed at enhancing organ donation rates.
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Affiliation(s)
- María Victoria Martínez-López
- Department of Philosophy I, FiloLab-UGR, University of Granada, Granada, Spain.
- Ethical Legal and Psychosocial Aspects of Organ Transplantation (ELPAT), European Society for Organ Transplantation (ESOT), Padua, Italy.
| | - Leah McLaughlin
- Ethical Legal and Psychosocial Aspects of Organ Transplantation (ELPAT), European Society for Organ Transplantation (ESOT), Padua, Italy
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Alberto Molina-Pérez
- Ethical Legal and Psychosocial Aspects of Organ Transplantation (ELPAT), European Society for Organ Transplantation (ESOT), Padua, Italy.
- Instituto de Estudios Sociales Avanzados (IESA), CSIC, Córdoba, Spain.
| | - Krzysztof Pabisiak
- Ethical Legal and Psychosocial Aspects of Organ Transplantation (ELPAT), European Society for Organ Transplantation (ESOT), Padua, Italy
- Dept Nephrology Transplantation and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Nadia Primc
- Ethical Legal and Psychosocial Aspects of Organ Transplantation (ELPAT), European Society for Organ Transplantation (ESOT), Padua, Italy
- Institute of History and Ethics of Medicine, Medical Department, Heidelberg University, Heidelberg, Germany
| | - Gurch Randhawa
- Ethical Legal and Psychosocial Aspects of Organ Transplantation (ELPAT), European Society for Organ Transplantation (ESOT), Padua, Italy
- Institute for Health Research, University of Bedfordshire, Bedfordshire, UK
| | - David Rodríguez-Arias
- Department of Philosophy I, FiloLab-UGR, University of Granada, Granada, Spain
- Ethical Legal and Psychosocial Aspects of Organ Transplantation (ELPAT), European Society for Organ Transplantation (ESOT), Padua, Italy
| | - Jorge Suárez
- Department of Philosophy I, FiloLab-UGR, University of Granada, Granada, Spain
| | - Sabine Wöhlke
- Ethical Legal and Psychosocial Aspects of Organ Transplantation (ELPAT), European Society for Organ Transplantation (ESOT), Padua, Italy
- Department Health Sciences, Faculty Life Science, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Janet Delgado
- Department of Philosophy I, FiloLab-UGR, University of Granada, Granada, Spain
- Ethical Legal and Psychosocial Aspects of Organ Transplantation (ELPAT), European Society for Organ Transplantation (ESOT), Padua, Italy
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Edwards L, Bentley C, Burgess M, Sapir-Pichhadze R, Hartell D, Keown P, Bryan S. Adding epitope compatibility to deceased donor kidney allocation criteria: recommendations from a pan-Canadian online public deliberation. BMC Nephrol 2023; 24:165. [PMID: 37296384 PMCID: PMC10255937 DOI: 10.1186/s12882-023-03224-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The widening supply-demand imbalance for kidneys necessitates finding ways to reduce rejection and improve transplant outcomes. Human leukocyte antigen (HLA) epitope compatibility between donor and recipient may minimize premature graft loss and prolong survival, but incorporating this strategy to deceased donor allocation criteria prioritizes transplant outcomes over wait times. An online public deliberation was held to identify acceptable trade-offs when implementing epitope compatibility to guide Canadian policymakers and health professionals in deciding how best to allocate kidneys fairly. METHODS Invitations were mailed to 35,000 randomly-selected Canadian households, with over-sampling of rural/remote locations. Participants were selected for socio-demographic diversity and geographic representation. Five two-hour online sessions were held from November-December 2021. Participants received an information booklet and heard from expert speakers prior to deliberating on how to fairly implement epitope compatibility for transplant candidates and governance issues. Participants collectively generated and voted on recommendations. In the final session, kidney donation and allocation policymakers engaged with participants. Sessions were recorded and transcribed. RESULTS Thirty-two individuals participated and generated nine recommendations. There was consensus on adding epitope compatibility to the existing deceased donor kidney allocation criteria. However, participants recommended including safeguards/flexibility around this (e.g., mitigating declining health). They called for a transition period to epitope compatibility, including an ongoing comprehensive public education program. Participants unanimously recommended regular monitoring and public sharing of epitope-based transplant outcomes. CONCLUSIONS Participants supported adding epitope compatibility to kidney allocation criteria, but advised safeguards and flexibility around implementation. These recommendations provide guidance to policymakers about incorporating epitope-based deceased donor allocation criteria.
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Affiliation(s)
- Louisa Edwards
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada.
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada.
| | | | - Michael Burgess
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
- W. Maurice Young Centre for Applied Ethics, UBC, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Vancouver, Canada
| | | | - Paul Keown
- Department of Medicine, UBC, Vancouver, Canada
- Immune Centre of BC, Vancouver Coastal Health, Vancouver, Canada
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Sprengholz P, Felgendreff L, Buyx A, Betsch C. Toward future triage regulations: Investigating preferred allocation principles of the German public. Health Policy 2023; 134:104845. [PMID: 37307760 DOI: 10.1016/j.healthpol.2023.104845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/26/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND When intensive care capacity is limited, triage may be required. Given that the German government started working on new triage legislation in 2022, the present study investigated the German public's preferences for intensive care allocation in two situations: ex-ante triage (where multiple patients compete for available resources) and ex-post triage (where admitting a new patient to intensive care means withdrawing treatment from another because ICU resources are depleted). METHOD In an online experiment, N=994 participants were presented with four fictitious patients who differed in age and pre- and post-treatment chance of survival. In a series of pairwise comparisons, participants were asked to select one patient for treatment or to opt for random selection. Ex-ante and ex-post triage situations were varied between participants and preferred allocation strategies were inferred from their decisions. RESULTS On average, participants prioritized better post-treatment prognosis ahead of younger age or treatment benefit. Many participants rejected random allocation (on the flip of a coin) or prioritization by worse pre-treatment prognosis. Preferences were similar for ex-ante and ex-post situations. DISCUSSION Although there may be good reasons for deviating from laypeople's preference for utilitarian allocation, the results can help to design future triage policies and accompanying communication strategies.
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Affiliation(s)
- Philipp Sprengholz
- Institute of Psychology, University of Bamberg, Bamberg, Germany; Health Communication, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
| | - Lisa Felgendreff
- Health Communication, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
| | - Alena Buyx
- Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany
| | - Cornelia Betsch
- Health Communication, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
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Abstract
PURPOSE OF REVIEW There is no widely accepted single ethical principle for the fair allocation of scarce donor organs for transplantation. Although most allocation systems use combinations of allocation principles, there is a particular tension between 'prioritizing the worst-off' and 'maximizing total benefits'. It is often suggested that empirical research on public preferences should help solve the dilemma between equity and efficiency in allocation policy-making. RECENT FINDINGS This review shows that the evidence on public preferences for allocation principles is limited, and that the normative role of public preferences in donor organ allocation policy making is unclear. The review seeks to clarify the ethical dilemma to the transplant community, and draws attention to recent attempts at balancing and rank-ordering of allocation principles. SUMMARY This review suggests that policy makers should make explicit the relative weights attributed to equity and efficiency considerations in allocation policies, and monitor the effects of policy changes on important ethics outcomes, including equitable access among patient groups. Also, it draws attention to wider justice issues associated not with the distribution of donor organs among patients on waiting lists, but with barriers in referral for transplant evaluation and disparities among patient groups in access to waiting lists.
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Affiliation(s)
- Eline M Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Slomp C, Edwards L, Burgess M, Sapir-Pichhadze R, Keown P, Bryan S. Public values and guiding principles for implementing epitope compatibility in kidney transplantation allocation criteria: results from a Canadian online public deliberation. BMC Public Health 2023; 23:844. [PMID: 37165330 PMCID: PMC10170053 DOI: 10.1186/s12889-023-15790-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/30/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Epitope compatibility in deceased donor kidney allocation is an emerging area of precision medicine (PM), seeking to improve compatibility between donor kidneys to transplant candidates in the hope of avoiding kidney rejection. Though the potential benefits of using epitope compatibility are promising, the implied modification of deceased organ allocation criteria requires consideration of significant clinical and ethical trade-offs. As a matter of public policy, these trade-offs should consider public values and preferences. We invited members of the Canadian public to participate in a deliberation about epitope compatibility in deceased donor kidney transplantation; to identify what is important to them and to provide recommendations to policymakers. METHODS An online public deliberation was conducted with members of the Canadian public, in which participants were asked to construct recommendations for policymakers regarding the introduction of epitope compatibility to kidney allocation criteria. In the present paper, a qualitative analysis was conducted to identify the values reflected in participants' recommendations. All virtual sessions were recorded, transcribed, and analyzed using NVivo 12 software. RESULTS Thirty-two participants constructed nine recommendations regarding the adoption of epitope compatibility into deceased donor kidney allocation. Five values were identified that drove participants' recommendations: Health Maximization, Protection/Mitigation of Negative Impacts, Fairness, Science/Evidence-based Healthcare, and Responsibility to Maintain Trust. Conflicts between these values were discussed in terms of operational principles that were required for epitope compatibility to be implemented in an acceptable manner: the needs for Flexibility, Accountability, Transparent Communication and a Transition Plan. All nine recommendations were informed by these four principles. Participant deliberations were often dominated by the conflict between Health Maximization and Fairness or Protection/Mitigation of Negative Impacts, which was discussed as the need for Flexibility. Two additional values (Efficient Use of Resources and Logic/Rationality) were also discussed and were reasons for some participants voting against some recommendations. CONCLUSIONS Public recommendations indicate support for using epitope compatibility in deceased donor kidney allocation. A flexible approach to organ allocation decision-making may allow for the balancing of Health Maximization against maintaining Fairness and Mitigating Negative Impacts. Flexibility is particularly important in the context of epitope compatibility and other PM initiatives where evidence is still emerging.
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Affiliation(s)
- Caitlin Slomp
- BC Children's Hospital Research Institute, 938 W 28th Ave, BC, V5Z 4H4, Vancouver, Canada.
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - Louisa Edwards
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Michael Burgess
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- W. Maurice Young Centre for Applied Ethics, University of British Columbia, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Paul Keown
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Immune Centre of BC, Vancouver Coastal Health, Vancouver, Canada
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Randhawa J, Hrazdil CT, McDonald PJ, Illes J. Strategic and principled approach to the ethical challenges of epilepsy monitoring unit triage. JOURNAL OF MEDICAL ETHICS 2023; 49:81-86. [PMID: 34497143 DOI: 10.1136/medethics-2020-107147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
Electroencephalographic monitoring provides critical diagnostic and management information about patients with epilepsy and seizure mimics. Admission to an epilepsy monitoring unit (EMU) is the gold standard for such monitoring in major medical facilities worldwide. In many countries, access can be challenged by limited resources compared to need. Today, triaging admission to such units is generally approached by unwritten protocols that vary by institution. In the absence of explicit guidance, decisions can be ethically taxing and are easy to challenge. In an effort to address this gap, we propose a two-component approach to EMU triage that takes into account the unique landscape of epilepsy monitoring informed by triage literature from other areas of medicine. Through the strategic component, we focus on the EMU wait list management infrastructure at the institutional level. Through the principled component, we apply a combination of the ethical principles of prioritarianism, utilitarianism and justice to triage; and we use individual case examples to illustrate how they apply. The effective implementation of this approach to specific epilepsy centres will need to be customised to the nuances of different settings, including diverse practice patterns, patient populations and constraints on resource distribution, but the conceptual consolidation of its components can alleviate some of the pressures imposed by the complex decisions involved in EMU triage.
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Affiliation(s)
- Jason Randhawa
- Neuroethics Canada, Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Neurology, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Chantelle T Hrazdil
- Division of Neurology, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Patrick J McDonald
- Neuroethics Canada, Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Neurosurgery, Department of Surgery, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Neurology, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Choudhary D, Thomas M, Pacheco-Barrios K, Zhang Y, Alonso-Coello P, Schünemann H, Hazlewood G. Methods to Summarize Discrete-Choice Experiments in a Systematic Review: A Scoping Review. THE PATIENT 2022; 15:629-639. [PMID: 35829927 DOI: 10.1007/s40271-022-00587-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Systematic reviews of discrete-choice experiments (DCEs) are being increasingly conducted. The objective of this scoping review was to identify and describe the methodologies that have been used to summarize results across DCEs. METHODS We searched the electronic databases MEDLINE and EMBASE from inception to March 18, 2021, to identify English-language systematic reviews of patient preferences that included at least two DCEs and extracted data on attribute importance. The methods used to summarize results across DCEs were classified into narrative, semi-quantitative, and quantitative (meta-analytic) approaches and compared. Approaches to characterize the extent of preference heterogeneity were also described. RESULTS From 7362 unique records, we identified 54 eligible reviews from 2010 to Mar 2021, across a broad range of health conditions. Most (83%) used a narrative approach to summarize findings of DCEs, often citing differences in studies as the reason for not formally pooling findings. Semi-quantitative approaches included summarizing the frequency of the most important attributes, the frequency of attribute statistical significance, or tabulated comparisons of attribute importance for each pair of attributes. One review conducted a meta-analysis using the maximum acceptable risk. While reviews often commented on the heterogeneity of patient preferences, few (6%) addressed this systematically across studies. CONCLUSION While not commonly used, several semi-quantitative and one quantitative approach for synthesizing results of DCEs were identified, which may be useful for generating summary estimates across DCEs when appropriate. Further work is needed to assess the validity and usefulness of these approaches.
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Affiliation(s)
- Daksh Choudhary
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Megan Thomas
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Sintesis de Evidencias en Salud, Lima, Peru
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Instituto de Investigación Biomédica (IIB Sant Pau), Centro Cochrane Iberoamericano, Barcelona, Spain
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Glen Hazlewood
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Shrestha P, Van Pilsum Rasmussen SE, Fazal M, Chu NM, Garonzik-Wang JM, Gordon EJ, McAdams-DeMarco M, Humbyrd CJ. Patient Perspectives on the Use of Frailty, Cognitive Function, and Age in Kidney Transplant Evaluation. AJOB Empir Bioeth 2022; 13:263-274. [PMID: 35802563 PMCID: PMC11288332 DOI: 10.1080/23294515.2022.2090460] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The allocation of scarce deceased donor kidneys is a complex process. Transplant providers are increasingly relying on constructs such as frailty and cognitive function to guide kidney transplant (KT) candidate selection. Patient views of the ethical issues surrounding the use of such constructs are unclear. We sought to assess KT candidates' attitudes and beliefs about the use of frailty and cognitive function to guide waitlist selection. METHODS KT candidates were randomly recruited from an ongoing single-center cohort study of frailty and cognitive function. Semi-structured interviews were conducted, and thematic analysis was performed. Inductively derived themes were mapped onto bioethics principles. RESULTS Twenty interviews were conducted (65% contact rate, 100% participation rate) (60% male; 70% White). With respect to the use of frailty and cognitive function in waitlisting decisions, four themes emerged in which participants: (1) valued maximizing a scarce resource (utility); (2) prioritized equal access to all patients (equity); (3) appreciated a proportional approach to the use of equity and utility (precautionary utility); and (4) sought to weigh utility- and equity-based concerns regarding social support. While some participants believed frailty and cognitive function were useful constructs to maximize utility, others believed their use would jeopardize equity. Patients were uncomfortable with using single factors such as frailty or cognitive impairment to deny someone access to transplantation; participants instead encouraged using the constructs to identify opportunities for intervention to improve frailty and cognitive function prior to KT. CONCLUSIONS KT candidates' values mirrored the current allocation strategy, seeking to balance equity and utility in a just manner, albeit with conflicting viewpoints on the appropriate use of frailty and cognitive impairment in waitlisting decisions.
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Affiliation(s)
- Prakriti Shrestha
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Maria Fazal
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nadia M. Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Elisa J. Gordon
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine
- Department of Surgery, Northwestern University Feinberg School of Medicine
| | | | - Casey Jo Humbyrd
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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Schomerus G, Leonhard A, Manthey J, Morris J, Neufeld M, Kilian C, Speerforck S, Winkler P, Corrigan PW. The stigma of alcohol-related liver disease and its impact on healthcare. J Hepatol 2022; 77:516-524. [PMID: 35526787 DOI: 10.1016/j.jhep.2022.04.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Abstract
People with alcohol-related liver disease (ALD) experience stigma and discrimination. This review summarises the evidence on stigma in healthcare and its implications for people with ALD, drawing from the literature on the stigma associated with mental illness and, specifically, alcohol use disorder (AUD). Public stigma, self-stigma and structural stigma all contribute to failure to seek help or delays in seeking help, inferior healthcare, and negative health outcomes, which increase the overall burden of ALD. Stigma can be experienced, but also anticipated and avoided, with both scenarios negatively impacting on ALD healthcare. Blaming people with ALD for their condition is central to the stigma of ALD. Stigma affects ALD healthcare at all stages, from prevention, early detection and intervention, to allocation of scarce resources in liver transplantation. People with lived experience need to be empowered to lead action against the stigmatisation of patients with ALD. Promulgating a dynamic model of individual and social responsibility for AUD, a continuum model of harmful alcohol use, and establishing training on ALD-related stigma for healthcare professionals are strategies to address stigma. Integrating addiction and ALD services, providing stigma-free prevention, and overcoming the frequent separation of addiction services from general healthcare are necessary. Beyond healthcare, addressing social inequality, the social dimensions of ALD risk and outcomes, and ensuring equal access to services is necessary to improve outcomes for all people with ALD. More research is needed on the stigma of ALD in low- and middle-income countries and in countries with restrictive drinking norms. Interventions to reduce the stigma of ALD and facilitate early help-seeking need to be developed and evaluated.
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Affiliation(s)
- Georg Schomerus
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany.
| | - Anya Leonhard
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany
| | - Jakob Manthey
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - James Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - Maria Neufeld
- World Health Organization European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Sven Speerforck
- Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Patrick W Corrigan
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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Israeli Medical Experts’ Knowledge, Attitudes, and Preferences in Allocating Donor Organs for Transplantation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116945. [PMID: 35682530 PMCID: PMC9180581 DOI: 10.3390/ijerph19116945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022]
Abstract
Medical advancement has increased the confidence in successful organ transplants in end-stage patients. As the waitlist of organ demand is multiplying, the organ allocation process is becoming more crucial. In this situation, a transparent and efficient organ allocation policy is required. This study evaluates the preferences of medical experts to substantial factors for allocating organs in different hypothetical scenarios. Twenty-five medical professionals with a significant role in organ allocation were interviewed individually. The interview questionnaire comprised demographic information, organ donation status, important organ allocation factors, public preference knowledge, and experts’ preferences in different hypothetical scenarios. Most medical experts rated the waiting time and prognosis as the most important, while the next of kin donor status and care and contribution to the well-being of others were the least important factors for organ allocation. In expert opinion, medical experts significantly considered public preferences for organ allocation in making their decisions. Altogether, experts prioritized waiting time over successful transplant, age, and donor status in the hypothetical scenarios. In parallel, less chance of finding another organ, donor status, and successful transplant were prioritized over age. Medical experts are the key stakeholders; therefore, their opinions are substantial in formulating an organ allocation policy.
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Dowling A, Lane H, Haines T. Community preferences for the allocation of scarce healthcare resources during the Covid-19 pandemic: a review of the literature. Public Health 2022; 209:75-81. [PMID: 35849934 PMCID: PMC9212404 DOI: 10.1016/j.puhe.2022.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
Objective The purpose of this thematic review is to examine the literature on the publics’ preferences of scarce medical resource allocation during COVID-19. Study design Literature review. Methods A review of Ovid MEDLINE, Embase, CINAHL and Scopus was performed between December 2019 and June 2022 for eligible articles. Results Fifteen studies using three methodologies and spanning five continents were included. Five key themes were identified: (1) prioritise the youngest; (2) save the most lives; (3) egalitarian allocation approaches; (4) prioritise healthcare workers; and (5) bias against particular groups. The public gave high priority to allocation that saved the most lives, particularly to patients who are younger and healthcare workers. Themes present but not supported as broadly were giving priority to individuals with disabilities, high frailty or those with behaviours that may have contributed to their ill-health (e.g. smokers). Allocation involving egalitarian approaches received the least support among community members. Conclusion The general public prefer rationing scarce medical resources in the COVID-19 pandemic based on saving the most lives and giving priority to the youngest and frontline healthcare workers rather than giving preference to patients with disabilities, frailty or perceived behaviours that may have contributed to their own ill-health. There is also little public support for allocation based on egalitarian strategies.
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12
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Díaz-Cobacho G, Cruz-Piqueras M, Delgado J, Hortal-Carmona J, Martínez-López MV, Molina-Pérez A, Padilla-Pozo Á, Ranchal-Romero J, Rodríguez-Arias D. Public Perception of Organ Donation and Transplantation Policies in Southern Spain. Transplant Proc 2022; 54:567-574. [PMID: 35303996 DOI: 10.1016/j.transproceed.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND This research explores how public awareness and attitudes toward donation and transplantation policies may contribute to Spain's success in cadaveric organ donation. MATERIALS AND METHODS A representative sample of 813 people residing in Andalusia (Southern Spain) were surveyed by telephone or via Internet between October and December 2018. RESULTS Most participants trust Spain's donation and transplantation system (93%) and wish to donate their organs after death (76%). Among donors, a majority have expressed their consent (59%), and few nondonors have expressed their refusal (14%). Only a minority are aware of the presumed consent system in force (28%) and feel sufficiently informed regarding the requirements needed to be an organ donor (16%). Participants mainly consider that relatives should represent the deceased's preferences and be consulted when the deceased's wishes are unknown, as is the case in Spain. CONCLUSION Public trust in the transplant system may contribute to Spain's high performance in organ donation. High levels of societal support toward organ donation and transplantation do not correspond with similar levels of public awareness of donation and transplantation policies in Spain.
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Affiliation(s)
- Gonzalo Díaz-Cobacho
- Department of Philosophy 1, University of Granada, Granada, Spain; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain
| | | | - Janet Delgado
- Department of Philosophy 1, University of Granada, Granada, Spain; ELPAT-ESOT Public Issues Working Group, European Society of Organ Transplantation, Padova, Italy; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain
| | - Joaquín Hortal-Carmona
- Department of Philosophy 1, University of Granada, Granada, Spain; Centro de salud Albayzín, Servicio Andaluz de Salud, Granada, Spain
| | - M Victoria Martínez-López
- Department of Philosophy 1, University of Granada, Granada, Spain; ELPAT-ESOT Public Issues Working Group, European Society of Organ Transplantation, Padova, Italy; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain
| | - Alberto Molina-Pérez
- Department of Philosophy 1, University of Granada, Granada, Spain; ELPAT-ESOT Public Issues Working Group, European Society of Organ Transplantation, Padova, Italy; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain; Institute for Advanced Social Studies, Spanish National Research Council (IESA-CSIC), Córdoba, Spain
| | - Álvaro Padilla-Pozo
- Department of Political and Social Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Julia Ranchal-Romero
- Institute for Advanced Social Studies, Spanish National Research Council (IESA-CSIC), Córdoba, Spain
| | - David Rodríguez-Arias
- Department of Philosophy 1, University of Granada, Granada, Spain; ELPAT-ESOT Public Issues Working Group, European Society of Organ Transplantation, Padova, Italy; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain.
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13
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Sypek MP, Howell M, Howard K, Wong G, Duncanson E, Clayton PD, Hughes P, McDonald S. Healthcare professional and community preferences in deceased donor kidney allocation: A best-worst scaling survey. Am J Transplant 2022; 22:886-897. [PMID: 34839582 DOI: 10.1111/ajt.16898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 01/25/2023]
Abstract
Deceased donor kidneys are a scarce community resource; therefore, the principles underpinning organ allocation should reflect societal values. This study aimed to elicit community and healthcare professional preferences for principles guiding the allocation of kidneys from deceased donors and compare how these differed across the populations. A best-worst scaling survey including 29 principles in a balanced incomplete block design was conducted among a representative sample of the general community (n = 1237) and healthcare professionals working in transplantation (n = 206). Sequential best-worst multinomial logistic regression was used to derive scaled preference scores (PS) (range 0-100). Thematic analysis of free text responses was performed. Five of the six most valued principles among members of the community related to equity, including priority for the longest waiting (PS 100), difficult to transplant (PS 94.5) and sickest (PS 93.9), and equitable access for men and women (PS 94.0), whereas the top four principles for healthcare professional focused on maximizing utility (PS 89.9-100). Latent class analysis identified unmeasured class membership among community members. There are discordant views between community members and healthcare professionals. These should be considered in the design, evaluation, and implementation of deceased donor kidney allocation protocols.
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Affiliation(s)
- Matthew P Sypek
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Emily Duncanson
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Philip D Clayton
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Hughes
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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14
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Bartling T, Oedingen C, Kohlmann T, Schrem H, Krauth C. How Should Deceased Donor Organs Be Allocated? The Patient's Perspective Derived from Semi-Structured Interviews. Patient Prefer Adherence 2022; 16:2375-2385. [PMID: 36065228 PMCID: PMC9440693 DOI: 10.2147/ppa.s372603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/12/2022] [Indexed: 12/04/2022] Open
Abstract
PURPOSE The gap between the supply and demand for deceased donor organs is increasing worldwide, while patients on waiting lists for organ transplantation die. This situation requires ethical donor organ allocation rules. The patients' perspective on donor organ allocation rules offers a highly relevant and unique perspective that may differ from the perspectives of physicians and the general public. PATIENTS AND METHODS Semi-structured telephone interviews were conducted with the regional group coordinators of the federal self-help organization for organ transplanted patients and their relatives in Germany in early 2021. Twelve interviews were conducted with patients and relatives of transplantation patients who received transplants for the affected organs including the lungs, heart, kidney, and liver. Transcripts were analyzed using the deductive framework method which was based on an earlier study. All criteria were reported following the COREQ statement. RESULTS Participants emphasized aspects of "medical urgency" and "effectiveness/benefit" of transplantation and associated trade-offs as well as the recipient's responsibility for organ failure ("own fault"), the appreciation for the gifted graft and the patient's capability of taking care of it ("appreciation/responsibility"). Patients acknowledged that urgent patients should be prioritized and they showed a clear preference toward allocation rules that strive to maximize both the life years and quality of life gained by transplantation. CONCLUSION The patients' perspective is unique in that patients agree on certain rules for allocation and share many preferences, but also have a hard time finding clear cutoff points when considering selecting a participant for allocation. Patient representatives should therefore be consulted in the debate on donor organ allocation rules.
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Affiliation(s)
- Tim Bartling
- Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover, Germany
- Correspondence: Tim Bartling, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany, Tel +49 511 532 9462, Fax +49 511 532 5376, Email
| | - Carina Oedingen
- Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Thomas Kohlmann
- Department for Methods of Community Medicine, Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Harald Schrem
- Center for Health Economics Research Hannover (CHERH), Hannover, Germany
- Transplant Center Graz, Medical University Graz, Graz, Austria
- General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Christian Krauth
- Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover, Germany
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15
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Bartling T, Oedingen C, Schrem H, Kohlmann T, Krauth C. 'As a surgeon, I am obliged to every single patient': evaluation of focus group discussions with transplantation physicians on the allocation of donor organs. Curr Opin Organ Transplant 2021; 26:459-467. [PMID: 34343155 DOI: 10.1097/mot.0000000000000908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Organ transplantation is the last resort for many patients. The ubiquitous shortage of suitable donor organs raises the question of best-justifiable allocation worldwide. This study investigates how physicians would allocate donor organs. METHODS Focus group discussions with a total of 12 transplant surgeons and 2 other transplant-related physicians were held at the annual conference of the German Transplantation Society (Oct 2019). Three groups discussed aspects of 'egalitarianism', 'effectiveness/benefit', 'medical urgency', 'own fault', 'medical background' and 'socio-demographic status'. RESULTS AND DISCUSSION It was observed that physicians often find themselves confronted with conflicts between (a) trying to advocate for their individual patients versus (b) seeing the systemic perspective and understanding the global impact of their decisions at the same time. The groups agreed that due to the current shortage of donor organs in the German allocation system, transplanted patients are often too sick at the point of transplantation and that a better balance between urgency and effectiveness is needed. The aspects of 'effectiveness' and 'urgency' were identified as the most challenging issues and thus were the main focus of debate. The dilemmas physicians find themselves in become increasingly severe, the larger the shortage of suitable donor organs is.
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Affiliation(s)
- Tim Bartling
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School
- Center for Health Economic Research Hannover (CHERH), Hannover, Germany
| | - Carina Oedingen
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School
- Center for Health Economic Research Hannover (CHERH), Hannover, Germany
| | - Harald Schrem
- Center for Health Economic Research Hannover (CHERH), Hannover, Germany
- Transplant Center Graz
- Department of Transplant Surgery, Medical University Graz, Graz, Austria
| | - Thomas Kohlmann
- Department for Methods of Community Medicine, Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School
- Center for Health Economic Research Hannover (CHERH), Hannover, Germany
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16
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The Costs of Organ Procurement - Another Case of Efficiency Versus Equity. Transplantation 2021; 105:2520-2521. [PMID: 33982915 DOI: 10.1097/tp.0000000000003668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Yousef MH, Alhalaseh YN, Mansour R, Sultan H, Alnadi N, Maswadeh A, Al-Sheble YM, Sinokrot R, Ammar K, Mansour A, Al-Hussaini M. The Fair Allocation of Scarce Medical Resources: A Comparative Study From Jordan. Front Med (Lausanne) 2021; 7:603406. [PMID: 33585506 PMCID: PMC7873904 DOI: 10.3389/fmed.2020.603406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 12/08/2020] [Indexed: 01/10/2023] Open
Abstract
The allocation strategies during challenging situations among the different social groups is based on 9 principles which can be considered either individually: sickest first, waiting list, prognosis, youngest first, instrumental values, lottery, monetary contribution, reciprocity, and individual behavior, or in combination; youngest first and prognosis, for example. In this study, we aim to look into the most important prioritization principles amongst different groups in the Jordanian population, in order to facilitate the decision-making process for any potential medical crisis. We conducted an online survey that tackled how individuals would deal with three different scenarios of medical scarcity: (1) organ donation, (2) limited hospital beds during an influenza epidemic, and (3) allocation of novel therapeutics for lung cancer. In addition, a free-comment option was included at the end of the survey if respondents wished to contribute further. Seven hundred and fifty-four survey responses were gathered, including 372 males (49.3%), and 382 females (50.7%). Five groups of individuals were represented including religion scholars, physicians, medical students, allied health practitioners, and lay people. Of the five surveyed groups, four found “sickest-first” to be the most important prioritization principle in all three scenarios, and only the physicians group documented a disagreement. In the first scenario, physicians regarded “sickest-first” and “combined-criteria” to be of equal importance. In general, no differences were documented between the examined groups in comparison with lay people in the preference of options in all three scenarios; however, physicians were more likely to choose “combination” in both the second and third scenarios (OR 3.70, 95% CI 1.62–8.44, and 2.62, 95% CI 1.48–4.59; p < 0.01), and were less likely to choose “sickest-first” as the single most important prioritization principle (OR 0.57, CI 0.37–0.88, and 0.57; 95% CI 0.36–0.88; p < 0.01). Out of 100 free comments, 27 (27.0%) thought that the “social-value” of patients should also be considered, adding the 10th potential allocation principle. Our findings are concordant with literature in terms of allocating scarce medical resources. However, “social-value” appeared as an important principle that should be addressed when prioritizing scarce medical resources in Jordan.
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Affiliation(s)
| | - Yazan N Alhalaseh
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Razan Mansour
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Hala Sultan
- School of Medicine, University of Jordan, Amman, Jordan
| | - Naseem Alnadi
- School of Medicine, University of Jordan, Amman, Jordan
| | | | | | | | - Khawlah Ammar
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Asem Mansour
- King Hussein Cancer Center, Amman, Jordan.,Human Research Protection Program, King Hussein Cancer Center, Amman, Jordan
| | - Maysa Al-Hussaini
- Human Research Protection Program, King Hussein Cancer Center, Amman, Jordan.,Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
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18
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Muñoz Sastre MT, Sorum PC, Kpanake L, Mullet E. French People's Views on the Allocation of Organs for Transplantation. Transplant Proc 2020; 53:520-528. [PMID: 32928555 DOI: 10.1016/j.transproceed.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/20/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND French laypeople's views on the allocation of organs for transplantation were examined. METHODS A total of 199 adults make judgments of priority for a liver transplant in 48 realistic scenarios composed of all combinations of 4 factors: 1. probability of success, 2. life expectancy without transplant, 3. level of responsibility for liver failure (eg, substance abuse in the past), and 4. social situation (eg, young mother with 2 young children). In all scenarios, the patients were in need of liver transplant. The ratings were subjected to cluster analysis and analyses of variance. RESULTS Six qualitatively different positions were found that were termed Probability of Success and Life Expectancy (6%), Family Responsibilities (8%), Family Responsibilities and Risky Behavior (28%), Risky Behavior and Family Responsibilities (22%), Risky Behavior (11%), and Always a Priority (25%). Regular church attendees expressed more often the Risky Behavior and Family Responsibilities position and less often the Always a Priority position than atheists. Female participants expressed more often the Risky Behavior position than male participants. CONCLUSIONS The French laypeople in our sample think that when assessing priority for transplant, criteria additional to medical urgency or the estimated utility in terms of expected life span after transplant should be taken into account. These criteria are the patient's lack of responsibility for the liver failure (ie, not causing it by drinking or using drugs) and the extent of the patient's social responsibilities (with active employment and dependents to care for).
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Affiliation(s)
| | - Paul Clay Sorum
- Department of internal medicine and pediatrics, Albany Medical College, Albany, New York
| | - Lonzozou Kpanake
- Department of social sciences, University of Québec-TELUQ, Montréal, Québec, Canada.
| | - Etienne Mullet
- Department of ethics and work, Institute of Advanced Studies, Paris, France
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19
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Oedingen C, Bartling T, Dierks ML, Mühlbacher AC, Schrem H, Krauth C. Public preferences for the allocation of donor organs for transplantation: Focus group discussions. Health Expect 2020; 23:670-680. [PMID: 32189453 PMCID: PMC7321724 DOI: 10.1111/hex.13047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Deceased donor organs are scarce resources because of a large supply-and-demand mismatch. This scarcity leads to an ethical dilemma, forcing priority-setting of how these organs should be allocated and whom to leave behind. OBJECTIVE To explore public preferences for the allocation of donor organs in regard to ethical aspects of distributive justice. METHODS Focus groups were facilitated between November and December 2018 at Hannover Medical School. Participants were recruited locally. Transcripts were assessed with content analysis using the deductive framework method. All identified and discussed criteria were grouped according to the principles of distributive justice and reported following the COREQ statement. RESULTS Six focus groups with 31 participants were conducted. Overall, no group made a final decision of how to allocate donor organ; however, we observed that not only a single criterion/principle but rather a combination of criteria/principles is relevant. Therefore, the public wants to allocate organs to save as many lives as possible by both maximizing success for and also giving priority to urgent patients considering the best compatibility. Age, waiting time, reciprocity and healthy lifestyles should be used as additional criteria, while sex, financial status and family responsibility should not, based on aspects of equality. CONCLUSIONS All participants recognized the dilemma that prioritizing one patient might cause another one to die. They discussed mainly the unclear trade-offs between effectiveness/benefit and medical urgency and did not establish an agreement about their importance. The results suggest a need of preference studies to elucidate public preferences in organ allocation.
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Affiliation(s)
- Carina Oedingen
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.,Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Tim Bartling
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.,Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Marie-Luise Dierks
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Axel C Mühlbacher
- Institute of Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany.,Duke Department of Population Health Sciences and Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Harald Schrem
- Department of General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria.,Transplant Center Graz, Medical University Graz, Graz, Austria
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.,Center for Health Economics Research Hannover (CHERH), Hannover, Germany
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20
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Bartling T, Oedingen C, Kohlmann T, Schrem H, Krauth C. Comparing preferences of physicians and patients regarding the allocation of donor organs: A systematic review. Transplant Rev (Orlando) 2020; 34:100515. [DOI: 10.1016/j.trre.2019.100515] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022]
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