Setting Organ Allocation Priorities: A Discrete Choice Experiment with German Patients and Their Relatives

Abstract

Tim Bartling,1,2 Carina Oedingen,1,2 Harald Schrem,2,3 Thomas Kohlmann,4 Christian Krauth1,2 1Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany; 2Center for Health Economics Research Hannover, Hannover, Germany; 3General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria; 4Department of Methods of Community Medicine, Institute for Community Medicine, University of Greifswald, Greifswald, GermanyCorrespondence: Tim Bartling, Medizinische Hochschule Hannover / Hannover Medical School, Institute of Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str, 1, Hannover, Lower Saxony, 30625, Germany, Tel [phone], Fax [phone], Email [email protected]: Organ transplantation systems benefit from guidelines that are harmonious with the preferences of the people involved. Discrete choice experiments are useful tools for eliciting preferences.Patients and Methods: This study evaluated the preferences of patients and their relatives (n=285) to identify their priorities in organ allocation using a discrete choice experiment. In eight hypothetical allocation decisions, the participants were asked to select the candidate they considered the most suitable The candidates differed in years of life gained after transplantation, quality of life after transplantation, waiting time until transplantation, age, compliance and social support.Results: The most important aspects for setting priority in organ allocation were lack of compliance (β= − 2.5, p 0.05). The comparison of the different relations to transplantation showed that life years gained after transplantation was of high relevance to posttransplant patients (+10 years: β = +0.709, p 0.05 / + 15 years: β = +0.173, p> 0.05) and relatives (+ 10 years: β = +0.063, p> 0.05 / +15 years: β = +0.304, p> 0.05).Conclusion: This study provides useful insights into the unique perspective of patients and their relatives on priority-setting in the allocation of donor organs that should be reflected in improved donor organ allocation rules.Keywords: organ transplantation, health priorities, health resources, ethics, patient involvement, resource allocation, discrete choice experiment

Keywords

• organ transplantation
• health priorities
• health resources
• ethics
• patient involvement
• resource allocation