Carina Oedingen1,2, Tim Bartling3,4, Axel C Mühlbacher5,6, Harald Schrem7,8, Christian Krauth3,4. 1. Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany. oedingen.carina@mh-hannover.de. 2. Center for Health Economics Research Hannover (CHERH), Hannover, Germany. oedingen.carina@mh-hannover.de. 3. Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany. 4. Center for Health Economics Research Hannover (CHERH), Hannover, Germany. 5. Institute of Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany. 6. Duke Department of Population Health Sciences and Duke Global Health Institute, Duke University, Durham, NC, USA. 7. Department of General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria. 8. Transplant Center Graz, Medical University Graz, Graz, Austria.
Abstract
BACKGROUND: Solid organ transplantation is the treatment of choice for organ failure, but donor organs are a scarce resource because of a large mismatch between supply and demand. This scarcity leads to an ethical dilemma, forcing priority setting in organ allocation to individual patients. Little is known about public preferences regarding priority setting in organ allocation. A systematic review was performed to review the existing evidence and provide an overview of the criteria and criterion levels in regard to ethical aspects of distributive justice. METHODS: The PubMed, Web of Science, EBSCO and PsycINFO databases were searched for literature published between January 2000 and December 2018. Only original studies were selected. The criteria were identified, extracted and grouped into a self-developed matrix according to the principles of distributive justice to ascertain public preferences. RESULTS: Overall, 9645 references were identified, and 15 studies were included. In total, 27 criteria clustered in seven theory-guided groups could be identified: "equality", "effectiveness/benefit", "medical urgency", "own fault", "value for society", "medical background" and "sociodemographic status". It was shown that not only a single principle but rather a combination of principles are relevant for the allocation. Therefore, a public propensity towards a rational utilitarian ethical model of allocation could be recognised. CONCLUSIONS: The general public not only wanted to allocate organs mainly to those with a good probability of having a successful transplantation but also wanted to consider those who need an organ most urgently to prevent fatal consequences, resulting in unclear trade-offs between effectiveness/benefit and medical urgency. Public preferences for organ allocation are therefore complex, and data regarding clear trade-offs are still lacking.
BACKGROUND: Solid organ transplantation is the treatment of choice for organ failure, but donor organs are a scarce resource because of a large mismatch between supply and demand. This scarcity leads to an ethical dilemma, forcing priority setting in organ allocation to individual patients. Little is known about public preferences regarding priority setting in organ allocation. A systematic review was performed to review the existing evidence and provide an overview of the criteria and criterion levels in regard to ethical aspects of distributive justice. METHODS: The PubMed, Web of Science, EBSCO and PsycINFO databases were searched for literature published between January 2000 and December 2018. Only original studies were selected. The criteria were identified, extracted and grouped into a self-developed matrix according to the principles of distributive justice to ascertain public preferences. RESULTS: Overall, 9645 references were identified, and 15 studies were included. In total, 27 criteria clustered in seven theory-guided groups could be identified: "equality", "effectiveness/benefit", "medical urgency", "own fault", "value for society", "medical background" and "sociodemographic status". It was shown that not only a single principle but rather a combination of principles are relevant for the allocation. Therefore, a public propensity towards a rational utilitarian ethical model of allocation could be recognised. CONCLUSIONS: The general public not only wanted to allocate organs mainly to those with a good probability of having a successful transplantation but also wanted to consider those who need an organ most urgently to prevent fatal consequences, resulting in unclear trade-offs between effectiveness/benefit and medical urgency. Public preferences for organ allocation are therefore complex, and data regarding clear trade-offs are still lacking.
Authors: Harald Schrem; Moritz Focken; Bridget Gunson; Benedikt Reichert; Darius Mirza; Hans-Heinrich Kreipe; Desley Neil; Alexander Kaltenborn; Alon Goldis; Christian Krauth; Keith Roberts; Thomas Becker; Jürgen Klempnauer; James Neuberger Journal: Liver Transpl Date: 2016-06 Impact factor: 5.799
Authors: Muhannad H Yousef; Yazan N Alhalaseh; Razan Mansour; Hala Sultan; Naseem Alnadi; Ahmad Maswadeh; Yasmeen M Al-Sheble; Raghda Sinokrot; Khawlah Ammar; Asem Mansour; Maysa Al-Hussaini Journal: Front Med (Lausanne) Date: 2021-01-12
Authors: Tim Bartling; Carina Oedingen; Thomas Kohlmann; Harald Schrem; Christian Krauth Journal: Patient Prefer Adherence Date: 2022-08-30 Impact factor: 2.314
Authors: Carina Oedingen; Tim Bartling; Marie-Luise Dierks; Axel C Mühlbacher; Harald Schrem; Christian Krauth Journal: Health Expect Date: 2020-03-18 Impact factor: 3.377