Community preferences for the allocation of solid organs for transplantation: a systematic review.
BACKGROUND
Organs for transplantation are a scarce community resource but community preferences and how they are incorporated into allocation policies are unclear. This systematic review aimed to ascertain community preferences for organ allocation and the principles underpinning these preferences.


METHODS
Medline, Embase, PsycINFO, EconLit, and gray literature databases were searched. Quantitative data were extracted, and a qualitative textual synthesis of the results and conclusions reported in each included study was performed.


RESULTS
Fifteen studies involving more than 5563 respondents were included. Seven themes describing community preferences for organ allocation were identified: (1) maximum benefit, to achieve maximum health gain in recipient survival and quality of life; (2) social valuation, to base preferences on societal gain; (3) moral deservingness, to consider the "worthiness" of recipients based on their social standing and lifestyle decisions; (4) prejudice, to make a judgement based on personal ideologic viewpoints; (5) "fair innings," to provide an organ preferentially to the younger recipient giving opportunity for a "normal" life span and to those waiting for a first organ rather than a retransplant; (6) "first come, first served," to allocate the organ to recipients wait-listed the longest; and (7) medical urgency, to allocate based on illness severity and saving life.


CONCLUSIONS
Community preferences for organ allocation hinge on a complex balance of efficiency, social valuation, morality, fairness, and equity principles. Being a community-held resource, effective ways to identify and incorporate community preferences into allocation algorithms for solid organ transplantation are warranted.
Tong
Allison
A
Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia. AllisonT@health.usyd.edu.au
Howard
Kirsten
K
Jan
Stephen
S
Cass
Alan
A
Rose
John
J
Chadban
Steven
S
Allen
Richard D
RD
Craig
Jonathan C
JC
D000465:Algorithms; D003153:Community Health Services / Q000331:legislation & jurisprudence / Q000458:organization & administration; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D015276:Health Care Rationing / Q000331:legislation & jurisprudence / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D009014:Morals; D016377:Organ Transplantation / Q000331:legislation & jurisprudence; D018579:Patient Selection; D011287:Prejudice; D011379:Prognosis; D011639:Public Opinion; D012928:Social Desirability; D012945:Social Values; D014019:Tissue Donors / Q000331:legislation & jurisprudence / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence / Q000458:organization & administration; D014850:Waiting Lists