Public preferences for the allocation of donor organs for transplantation: Focus group discussions

• Published in: Health expectations : an international journal of public participation in health care and health policy 2020-06, Vol.23 (3), p.670-680
• Main Authors: Oedingen, Carina, Bartling, Tim, Dierks, Marie‐Luise, Mühlbacher, Axel C., Schrem, Harald, Krauth, Christian
• Format: Article
• Language: English
• Subjects: attitudes; Biological organs; Blood & organ donations; Clinical decision making; Content analysis; Criteria; Decision making; Distributive justice; Egalitarianism; Equality; Ethics; focus group discussion; Focus groups; Medical ethics; Medical prognosis; Medical schools; organ allocation; organ transplantation; Organs; Original Research Paper; Original Research Papers; Patients; preferences; Principles; Prioritizing; Professional ethics; public perspective; Qualitative research; Reciprocity; Scarcity; Sociodemographics; Supply & demand; Systematic review; Transplantation; Transplants; Transplants & implants; Urgency
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1111/hex.13047

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.