Patients’ preferences in transplantation from marginal donors: results of a discrete choice experiment

Abstract

To increase the donor pool, the strategy of transplantation from "marginal" donors was developed though patients' preferences about these donors were insufficiently known. The preferences of patients registered on the waiting list or already transplanted in eight transplant teams covering four main organs (i.e., kidney, liver, heart, and lung) were evaluated using the discrete choice experiment method. In each left during 2 days, patients were interviewed on four scenarios. Of 178 eligible patients, 167 were interviewed; 40% accepted marginal graft in their own situation and 89% at least in one of the scenarios. Imagining urgent situations or rare profiles with difficult access to transplantation, respectively, 86% and 71% accepted these grafts. Most (76%) preferred to be informed about these grafts and 43% preferred to be involved in decision. The emergency [OR = 1.24; 95% CI: (1.06-1.45)] and the hazardousness [OR = 0.88; 95% CI: (0.78-0.99)] of the transplantation were factors independently associated with marginal graft acceptance. Most patients preferred to be informed and to be involved in the decision. Marginal grafts could be more accepted by patients in critical medical situations or perceiving their situation as critical. Physicians' practices in transplantation should be reconsidered taking into account individual preferences. This study was performed in a single country and thus reflects the cultural bias and practice thereof.

A single‐center long‐term experience with marginal donor utilization for heart transplantation

“…However, patients implanted with LVAD have a progressive decline of survival due to hemorrhagic, thrombotic, and infective complications compared with survival of recipients that remains relatively stable after HT, and they undergo transplantation mainly in case of emerging complications 26 . When LVAD implantation is contraindicated and heart transplantation is the only option, patients should be involved in the decision and be informed about the risk of higher mortality when using marginal donors 27 …”

“…26 When LVAD implantation is contraindicated and heart transplantation is the only option, patients should be involved in the decision and be informed about the risk of higher mortality when using marginal donors. 27 Univariate and multivariate analysis highlighted that marginal donor criteria do not affect recipient outcome in the same way; some criteria are strictly related to the quality of the heart, while others as D/R-PHM ratio or ischemic time > 4 hours does not necessarily mean that the heart itself is unsuitable for transplantation. HT can be safely performed using low D/R-WR donors between sex-matched and male to female transplants; however, in female to male transplants, using of low D/R-WR donors is associated with decreased survival.…”

Outcomes of Organ Transplantation from Donors with a Cancer History

“…Donors with malignancy history are marginal donors because they are possibly associated with higher risks than reference donors [ 6 , 7 ]. Marginal grafts could be more frequently accepted by patients in critical medical situations or patients who perceive their situation as critical [ 8 ]. In turn, this acceptance may help reduce mortality in those on transplant waiting lists, benefiting the largest number of recipients [ 9 ].…”

Organ utilization – the next hurdle in transplantation?

“…Time spent in presentation of risk is often helpful [83] although technologies such as a mobile app or other web‐based approaches may not translate into greater acceptance of IRD organs [84,85]. Of course, the potential recipient has the right to agree or disagree whether to accept an organ and most patients want to be involved in that decision [86]. In the UK, it is recommended that potential recipients are asked prior to activation on the list if they wish to have all organ offers discussed with them or not.…”