Principles of distributive justice used by members of the general public in the allocation of donor liver grafts for transplantation: a qualitative study.

OBJECTIVE: To investigate the nature of public preferences in the allocation of donor liver grafts for transplantation.
DESIGN: A qualitative study based upon the transcripts of four focus groups.
SETTING: Derby, Derbyshire, UK. PARTICIPANTS: Twenty-two members of the public in the Derby locality, recruited to one of four focus groups through local community groups. MAIN OUTCOME MEASURES: The views of focus group members as to the importance (or otherwise) of several potential discriminating factors which could be used in the prioritization of patients on the waiting list for liver transplantation were ascertained. The factors included were expected post-transplant prognosis, the age of the patient, whether the patient was personally responsible for their illness, the time spent on the waiting list, re-transplantation or primary transplant and the social background of the patient. RESULTS AND
CONCLUSIONS: Group members explored the criteria from a number of perspectives, and made some unexpected linkages between the criteria and wider moral principles. They did not come to firm conclusions about the relative desirability of the criteria, but their approach was notably flexible and thoughtful, with the exception of a few instances where they appeared to resort to arguments based on what is 'obvious' and 'natural'. The results of these discussions suggest that members of the public would be able and willing to respond positively to a more open and consultative system of donor liver prioritization than exists presently within the UK.