Current opinions in organ allocation

Abstract

Existing methods of academic publication provide limited opportunity to obtain stakeholder input on issues of broad interest. This article reports the results of an experiment to produce a collaborative, crowdsourced article examining a current controversial issue in transplant medicine (hereby referred to as the "C4 Article"). The editorial team as a whole selected the topic of organ allocation, then divided into six sections, each supported by an individual editorial team. Widely promoted by the American Journal of Transplantation, the C4 Article was open for public comment for 1 month. The nonblinded editorial teams reviewed the contributions daily and interacted with contributors in near-real time to clarify and expand on the content received. Draft summaries of each section were posted and subsequently revised as new contributions were received. One hundred ninety-four individuals viewed the manuscript, and 107 individuals contributed to the manuscript during the submission period. The article engaged the international transplant community in producing a contemporary delineation of issues of agreement and controversy related to organ allocation and identified opportunities for new policy development. This initial experience successfully demonstrated the potential of a crowdsourced academic manuscript to advance a broad-based understanding of a complex issue. K E Y W O R D S disparities, donors and donation, editorial/personal viewpoint, organ transplantation in general, waitlist management 1 | INTRODUC TI ON This manuscript is the result of an experiment to produce a collaborative, crowdsourced article examining a current and controversial issue in the field of transplantation. This C4 Article examines the issue of organ allocation. The perennial shortage of organs impacts all aspects of transplantation from basic research to health policy. Unlike other areas of medicine in which the need for care exceeds available resources, the scarcity of organs for transplantation cannot be rectified by a simple injection of funds. The rationing of available lifesaving organs is a reality of contemporary transplant medicine achieved through organ allocation rules. Principles of both utility and justice inform these rules. In the context of organ allocation, these principles are frequently in conflict. Periodic review of organ allocation policies ensures the optimal balance of the principles of justice and utility, and ensures policies are consistent with the values of all stakeholders. This C4 Article provides a unique opportunity to acquire broad stakeholder input on several key issues related to organ allocation policy. Contributors examined six issues selected by the editors, including who should determine organ allocation policy, which policies should be adopted to increase organ utilization, what is the minimal acceptable outcome for an organ transplant, what role should patient choice play in organ allocation policy, should nonmedical factors be used in organ allocation policy, and which policies should be advanced...

Outcomes after kidney transplantation, let’s focus on the patients’ perspectives

“…For instance, doctors and patients can choose the most suitable renal replacement therapy not only based on patient survival, but also HRQOL. Furthermore, stakeholders within the transplant community have argued that the current organ allocation policy that values longevity is outdated, and a comprehensive evaluation involving post-transplant HRQOL, functional status and cost is more relevant [ 40 ]. Prediction models comprising both clinical outcomes and PROs can be developed to facilitate the above process.…”