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Systematic Review of Public Preferences for the Allocation of Donor Organs for Transplantation: Principles of Distributive Justice

Author

Listed:
  • Carina Oedingen

    (Hannover Medical School
    Center for Health Economics Research Hannover (CHERH))

  • Tim Bartling

    (Hannover Medical School
    Center for Health Economics Research Hannover (CHERH))

  • Axel C. Mühlbacher

    (Institute of Health Economics and Health Care Management
    Duke University)

  • Harald Schrem

    (Medical University Graz
    Medical University Graz)

  • Christian Krauth

    (Hannover Medical School
    Center for Health Economics Research Hannover (CHERH))

Abstract

Background Solid organ transplantation is the treatment of choice for organ failure, but donor organs are a scarce resource because of a large mismatch between supply and demand. This scarcity leads to an ethical dilemma, forcing priority setting in organ allocation to individual patients. Little is known about public preferences regarding priority setting in organ allocation. A systematic review was performed to review the existing evidence and provide an overview of the criteria and criterion levels in regard to ethical aspects of distributive justice. Methods The PubMed, Web of Science, EBSCO and PsycINFO databases were searched for literature published between January 2000 and December 2018. Only original studies were selected. The criteria were identified, extracted and grouped into a self-developed matrix according to the principles of distributive justice to ascertain public preferences. Results Overall, 9645 references were identified, and 15 studies were included. In total, 27 criteria clustered in seven theory-guided groups could be identified: “equality”, “effectiveness/benefit”, “medical urgency”, “own fault”, “value for society”, “medical background” and “sociodemographic status”. It was shown that not only a single principle but rather a combination of principles are relevant for the allocation. Therefore, a public propensity towards a rational utilitarian ethical model of allocation could be recognised. Conclusions The general public not only wanted to allocate organs mainly to those with a good probability of having a successful transplantation but also wanted to consider those who need an organ most urgently to prevent fatal consequences, resulting in unclear trade-offs between effectiveness/benefit and medical urgency. Public preferences for organ allocation are therefore complex, and data regarding clear trade-offs are still lacking.

Suggested Citation

  • Carina Oedingen & Tim Bartling & Axel C. Mühlbacher & Harald Schrem & Christian Krauth, 2019. "Systematic Review of Public Preferences for the Allocation of Donor Organs for Transplantation: Principles of Distributive Justice," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 12(5), pages 475-489, October.
    • Handle: RePEc:spr:patien:v:12:y:2019:i:5:d:10.1007_s40271-019-00363-0
    DOI: 10.1007/s40271-019-00363-0
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    References listed on IDEAS

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    1. Dolan, Paul & Shaw, Rebecca, 2004. "A note on a discussion group study of public preferences regarding priorities in the allocation of donor kidneys," Health Policy, Elsevier, vol. 68(1), pages 31-36, April.
    2. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    3. Julie Ratcliffe, 2000. "Public preferences for the allocation of donor liver grafts for transplantation," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 137-148, March.
    4. Wagstaff, Adam, 1991. "QALYs and the equity-efficiency trade-off," Journal of Health Economics, Elsevier, vol. 10(1), pages 21-41, May.
    5. Browning, Colette J. & Thomas, Shane A., 2001. "Community values and preferences in transplantation organ allocation decisions," Social Science & Medicine, Elsevier, vol. 52(6), pages 853-861, March.
    6. Olsen, Jan Abel, 1997. "Theories of justice and their implications for priority setting in health care," Journal of Health Economics, Elsevier, vol. 16(6), pages 625-639, December.
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    1. Oedingen, Carina & Bartling, Tim & Schrem, Harald & Mühlbacher, Axel C. & Krauth, Christian, 2021. "Public preferences for the allocation of donor organs for transplantation: A discrete choice experiment," Social Science & Medicine, Elsevier, vol. 287(C).
    2. Amir Elalouf, 2022. "Israeli Medical Experts’ Knowledge, Attitudes, and Preferences in Allocating Donor Organs for Transplantation," IJERPH, MDPI, vol. 19(11), pages 1-17, June.
    3. Sprengholz, Philipp & Felgendreff, Lisa & Buyx, Alena & Betsch, Cornelia, 2023. "Toward future triage regulations: Investigating preferred allocation principles of the German public," Health Policy, Elsevier, vol. 134(C).

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