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Bartling T, Oedingen C, Schrem H, Kohlmann T, Krauth C. Setting Organ Allocation Priorities: A Discrete Choice Experiment with German Patients and Their Relatives. Patient Prefer Adherence 2023; 17:827-838. [PMID: 36999164 PMCID: PMC10044066 DOI: 10.2147/ppa.s402203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/09/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE Organ transplantation systems benefit from guidelines that are harmonious with the preferences of the people involved. Discrete choice experiments are useful tools for eliciting preferences. PATIENTS AND METHODS This study evaluated the preferences of patients and their relatives (n=285) to identify their priorities in organ allocation using a discrete choice experiment. In eight hypothetical allocation decisions, the participants were asked to select the candidate they considered the most suitable The candidates differed in years of life gained after transplantation, quality of life after transplantation, waiting time until transplantation, age, compliance and social support. RESULTS The most important aspects for setting priority in organ allocation were lack of compliance (β= -2.5, p<0.001) and good quality of life after transplantation (β = +1.4, p<0.001). The lack of social support (ß = -0.8, p<0.05) and the more years of life gained after transplantation (β = +0.5, p<0.001) had less but still a significant amount of influence on this decision, while the waiting list was not considered significantly important (β = 0.1, p>0.05). The comparison of the different relations to transplantation showed that life years gained after transplantation was of high relevance to posttransplant patients (+10 years: β = +0.709, p<0.001 / +15 years: β = +0.700, p<0.001) and of no importance to waitlisted patients (+10 years: β = +0.345, p>0.05 / + 15 years: β = +0.173, p>0.05) and relatives (+ 10 years: β = +0.063, p>0.05 / +15 years: β = +0.304, p>0.05). CONCLUSION This study provides useful insights into the unique perspective of patients and their relatives on priority-setting in the allocation of donor organs that should be reflected in improved donor organ allocation rules.
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Affiliation(s)
- Tim Bartling
- Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
- Center for Health Economics Research Hannover, Hannover, Germany
- Correspondence: Tim Bartling, Medizinische Hochschule Hannover / Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str, 1, Hannover, Lower Saxony, 30625, Germany, Tel +49 511 532 9462, Fax +49 511 532 5376, Email
| | - Carina Oedingen
- Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
- Center for Health Economics Research Hannover, Hannover, Germany
| | - Harald Schrem
- Center for Health Economics Research Hannover, Hannover, Germany
- General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Thomas Kohlmann
- Department of Methods of Community Medicine, Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Christian Krauth
- Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
- Center for Health Economics Research Hannover, Hannover, Germany
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Ionescu VA, Diaconu CC, Bungau S, Jinga V, Gheorghe G. Current Approaches in the Allocation of Liver Transplantation. J Pers Med 2022; 12:jpm12101661. [PMID: 36294801 PMCID: PMC9605642 DOI: 10.3390/jpm12101661] [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: 08/19/2022] [Revised: 09/26/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
In recent decades, important advances have been made in the field of liver transplantation. One of the major problems remaining in this area is the small number of donors. Thus, recent data bring multiple updates of the indications and contraindications of this therapeutic method. The main goal is to increase the number of patients who can benefit from liver transplantation, a therapeutic method that can improve life expectancy and the quality of life of patients with end-stage liver disease. Another goal in the management of these patients is represented by the optimal care of those on the waiting list during that period. A multidisciplinary team approach is necessary to obtain the best results for both the donor and the recipient.
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Affiliation(s)
- Vlad Alexandru Ionescu
- “Prof. Dr. Theodor Burghele” Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Camelia Cristina Diaconu
- “Prof. Dr. Theodor Burghele” Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
- Medical Sciences Section, Academy of Romanian Scientists, 050085 Bucharest, Romania
- Correspondence: (C.C.D.); (S.B.); Tel.: +40-726-377-300 (C.C.D.)
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
- Correspondence: (C.C.D.); (S.B.); Tel.: +40-726-377-300 (C.C.D.)
| | - Viorel Jinga
- “Prof. Dr. Theodor Burghele” Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
- Medical Sciences Section, Academy of Romanian Scientists, 050085 Bucharest, Romania
- Department of Urology, “Prof. Dr. Theodor Burghele” Hospital, 050653 Bucharest, Romania
| | - Gina Gheorghe
- “Prof. Dr. Theodor Burghele” Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
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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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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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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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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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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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