Community Preferences for the Allocation of Solid Organs for Transplantation: A Systematic Review

Tong, Allison; Howard, Kirsten; Jan, S.; Cass, Alan; Rose, John M.; Chadban, Steve; Allen, Ruth; Craig, Jonathan C.

doi:10.1097/00007890-201007272-01040

Cited by 17 publications

(26 citation statements)

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“…The findings, nevertheless, indicate that financial means are preferably seen as means of communication in reciprocal relationships after organ donation has been decided on, rather than as incentives motivating donation in the first place. This conclusion would be in harmony with findings from a systematic review of public perceptions of allocation models , which found that the ability to pay for an organ should not influence allocations. It is compatible with recent legal scholarship suggesting gift law as the optimal juridical framework for organ donation , as well as recent assessments of the relative success of already implemented initiatives to improve donation rates .…”

Section: Discussionsupporting

confidence: 72%

Public attitudes to financial incentive models for organs: a literature review suggests that it is time to shift the focus from ‘financial incentives’ to ‘reciprocity’

Hoeyer

Schicktanz²,

Deleuran

2013

Transpl Int

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SummaryWaiting lists for organs have stimulated interest in the use of financial incentives for organ donation (FIs), but the literature does not contain an adequate overview of studies of public attitudes toward this mode of procurement. We conducted a literature review of international peer-reviewed research published between 2002 and 2012 on how members of the public position themselves toward FIs. We identified and analyzed 23 studies using MEDLINE, PsycINFO, Sociological Abstracts and cross-reference search. The search included whole organs, donation, quantitative and empirical qualitative social scientific studies on, public attitudes (excluding professionals and medical students). The review reveals a broad divergence of public opinions on financial incentives. However, quantitative studies showed a low overall level of acceptance of payment for organs in living donation (LD); only a slightly higher one for deceased donation (DD); and a general preference for alternative forms, such as removal of disincentives or expressions of social reciprocity. Across different national and methodological settings we observed a considerable preference of noncommercial forms. This does not preclude the opportunity to consider various types of acknowledgement of economic value given in return for the organ. This provides reason to shift the focus from incentives to reciprocity.

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Section: Discussionsupporting

confidence: 72%

Public attitudes to financial incentive models for organs: a literature review suggests that it is time to shift the focus from ‘financial incentives’ to ‘reciprocity’

Hoeyer

Schicktanz²,

Deleuran

2013

Transpl Int

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“…Coupled with the changing demographics of end-stage lung disease, this has led to increased allocation to older patients, who, at the extreme, derive less long-term survival benefit from transplantation. Surveys of community beliefs about appropriate organ allocation have consistently identified prioritizing younger age-and the chance to live a normal life span or to have a fair number of life "innings"-as important to equitable allocation (35). As with current lung transplantation guidelines, respondents in these community-based surveys do not identify a specific age cutoff, but there is an ongoing tension between a commitment to fair innings and to a system that increases the number of elderly transplant recipients.…”

Section: Duty To Rescue and Fair Inningsmentioning

confidence: 99%

Lung transplantation in elderly patients

Courtwright

Cantu

2017

J. Thorac. Dis.

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Consensus statements on the selection of lung transplant candidates have consistently identified older age as a relative contraindication to transplantation. A combination of population-level demographic changes, revision of the lung allocation score (LAS), and clearer data on outcomes in elderly transplant recipients has, however, driven a steady increase in the threshold at which age is taken into consideration. This article reviews the current state of lung transplantation in elderly patients with an emphasis on the factors that have increased lung transplantation in older age groups, their expected outcomes including survival and health-related quality of life, and the factors that go in to appropriate candidate and procedure selection in this population.

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“…Strategies are needed to make more transparent this process of allocating this scarce community resource and to ensure that it is carried out in a manner consistent with values of the broader community. Interestingly, a recent systematic review of community preferences for the allocation of deceased donor organs for transplantation uncovered similar principles to those found here including efficiency, social valuation, moral deservingness, fair innings, first come first served, and medical urgency .…”

Section: Discussionmentioning

confidence: 99%

“…We assessed the explicitness and comprehensiveness of reporting of each primary study. For the surveys, we used a framework used in a previous review that was developed based on primary survey research and published guides (Table S2). For the qualitative studies, we used the “consolidated criteria for reporting qualitative research (COREQ)” tool which included criteria relating to the research team, study methods and methodology, context of the study, and analysis and interpretations (Table S3).…”

Section: Methodsmentioning

confidence: 99%

Rationing scarce organs for transplantation: healthcare provider perspectives on wait‐listing and organ allocation

Tong

Jan

Wong

et al. 2012

Clinical Transplantation

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Ongoing debate about how to maximize the benefit of scarce organs while maintaining equity of access to transplantation exists. This study aims to synthesize healthcare provider perspectives on wait-listing and organ allocation. MEDLINE, Embase, and PsycINFO were searched till February 21, 2011. Quantitative data were extracted, and a qualitative synthesis of the studies was conducted. Twenty studies involving 4254 respondents were included. We identified two goals underpinning healthcare provider preferences for organ allocation: (i) maximize clinical benefit (quality of life gains, patient survival, treatment adherence, and graft survival) and social outcomes (social support, productivity, and valuation); (ii) achieve equity (waiting time, patient preferences, access to live donation, and medical urgency). Maximizing clinical or social outcomes meant organs would be preferentially given to patients expected to achieve good transplant outcomes or wider social gain. Achieving equity meant all patients should have an equal chance of transplant, or patients deemed more urgent receive higher priority. A tension between equity and efficiency is apparent. Balanced against dimensions of efficiency were considerations to instill a degree of perceived fairness in organ allocation. Ongoing engagement with stakeholders is needed to enhance transparency, a reasonable balance between efficiency and equity, and avoid discrimination against specific populations.

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Community Preferences for the Allocation of Solid Organs for Transplantation: A Systematic Review

Cited by 17 publications

References 0 publications

Public attitudes to financial incentive models for organs: a literature review suggests that it is time to shift the focus from ‘financial incentives’ to ‘reciprocity’

Public attitudes to financial incentive models for organs: a literature review suggests that it is time to shift the focus from ‘financial incentives’ to ‘reciprocity’

Lung transplantation in elderly patients

Rationing scarce organs for transplantation: healthcare provider perspectives on wait‐listing and organ allocation

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