Who should be prioritized for renal transplantation?: Analysis of key stakeholder preferences using discrete choice experiments

Abstract

BackgroundPolicies for allocating deceased donor kidneys have recently shifted from allocation based on Human Leucocyte Antigen (HLA) tissue matching in the UK and USA. Newer allocation algorithms incorporate waiting time as a primary factor, and in the UK, young adults are also favoured. However, there is little contemporary UK research on the views of stakeholders in the transplant process to inform future allocation policy. This research project aimed to address this issue.MethodsDiscrete Choice Experiment (DCE) questionnaires were used to establish priorities for kidney transplantation among different stakeholder groups in the UK. Questionnaires were targeted at patients, carers, donors / relatives of deceased donors, and healthcare professionals. Attributes considered included: waiting time; donor-recipient HLA match; whether a recipient had dependents; diseases affecting life expectancy; and diseases affecting quality of life.ResultsResponses were obtained from 908 patients (including 98 ethnic minorities); 41 carers; 48 donors / relatives of deceased donors; and 113 healthcare professionals. The patient group demonstrated statistically different preferences for every attribute (i.e. significantly different from zero) so implying that changes in given attributes affected preferences, except when prioritizing those with no rather than moderate diseases affecting quality of life. The attributes valued highly related to waiting time, tissue match, prioritizing those with dependents, and prioritizing those with moderate rather than severe diseases affecting life expectancy. Some preferences differed between healthcare professionals and patients, and ethnic minority and non-ethnic minority patients. Only non-ethnic minority patients and healthcare professionals clearly prioritized those with better tissue matches.ConclusionsOur econometric results are broadly supportive of the 2006 shift in UK transplant policy which emphasized prioritizing the young and long waiters. However, our findings suggest the need for a further review in the light of observed differences in preferences amongst ethnic minorities, and also because those with dependents may be a further priority.

Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments

“…The composition of the studies was heterogeneous; although just over half of the studies (n=20) compared one group of healthcare providers with either patients (or in the case of screening, those who had experienced the test) 9 32 34 36 38 40–45 47 54 55 58 60 61 64 65 or the general population, 31 12 studies compared the preferences of patients 33 35 37 46 48 49 51 52 56 57 67 or parents of patients 39 with multiple healthcare providers, and the remainder varied in either their non-healthcare provider 53 59 63 or both non-healthcare provider and healthcare provider groups. 50 62 66 …”

Public attitudes toward contemporary issues in liver allocation

“…[6][7][8] For example, in a discrete choice experiment about renal transplantation, respondents preferred policies that recognized the importance of recipient age, societal responsibilities, time on the waitlist, life expectancy, and posttransplant quality of life. 9,10 Another study of priorities for patients with renal failure in receiving kidneys identified preferences for "enhancing life, medical priority, recipient valuation, and deservingness." 11 In some cases, public opinion conflicts with generally accepted medical ethics, for example, when a surveyed population felt that allocation should depend on whether patients caused their own disease.…”

Meeting report: 2nd international conference: antibody incompatible transplantation and transplant infectious disease

“…Thus evaluation of cost‐effectiveness is a key factor for new healthcare technologies. Professor Ala Szczepura has published widely on health economics, including a recent study looking at allocation of deceased donor kidneys for transplantation (Clark et al ., ).…”