Public attitudes toward contemporary issues in liver allocation. Issue 4 (22nd January 2019)

• Record Type: Journal Article
• Authors: O'Dell, Heather W.; McMichael, Benjamin J.; Lee, Suzie; Karp, Jay L.; VanHorn, R. Lawrence; Karp, Seth J.
• Is Part Of: American journal of transplantation. Volume 19:Issue 4(2019)
• Page Start: 1212
• Page End: 1217
• Publication Date: 2019-01-22
• Subjects: ethics and public policy -- health services and outcomes research -- organ procurement and allocation -- social sciences -- survey -- United Network for Organ Sharing (UNOS); Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15227
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Allocation of scarce livers for transplantation seeks to balance competing ethical principles of autonomy, utility, and justice. Given the history and ongoing dependence of transplantation on public support for funding and organs, understanding and incorporating public attitudes into allocation decisions seems appropriate. In the context of the current controversy around liver allocation, we sought to determine public preferences about issues relevant to the debate. We performed multiple surveys of attitudes around donation and evaluated these using conjoint analysis and clarifying follow‐up questions. We found little public support that allocation decisions should be based solely on risk of waiting‐list mortality. Strong public sentiment supported maximizing outcomes after transplantation, prioritizing US citizens or residents, keeping organs local, and considering cost in allocation decisions. We then present a methodology for incorporating these preferences into the Model for End‐Stage Liver Disease (or MELD) priority score. Taken together, these findings suggest that current allocation schemes do not accurately reflect public preferences and suggest a framework to better align allocation with the values of the public. Abstract : Surveys of attitudes around liver donation evaluated using conjoint analysis and clarifying follow‐up questions identify differences between allocation rules and public preferences with respect to incorporating outcomes after transplant, prioritizing US citizens or residents, keeping organs local, and including cost in allocation decisions.