title: Patient preferences for the allocation of deceased donor kidneys for transplantation: a mixed methods study.
abstract: BACKGROUND
  Deceased donor kidneys are a scarce health resource, yet patient preferences for organ allocation are largely unknown. The aim of this study was to determine patient preferences for how kidneys should be allocated for transplantation.
  
  
  METHODS
  Patients on dialysis and kidney transplant recipients were purposively selected from two centres in Australia to participate in nominal/focus groups in March 2011. Participants identified and ranked criteria they considered important for deceased donor kidney allocation. Transcripts were thematically analysed to identify reasons for their rankings.
  
  
  RESULTS
  From six groups involving 37 participants, 23 criteria emerged. Most agreed that matching, wait-list time, medical urgency, likelihood of surviving surgery, age, comorbidities, duration of illness, quality of life, number of organs needed and impact on the recipient's life circumstances were important considerations. Underpinning their rankings were four main themes: enhancing life, medical priority, recipient valuation, and deservingness. These were predominantly expressed as achieving equity for all patients, or priority for specific sub-groups of potential recipients regarded as more "deserving".
  
  
  CONCLUSIONS
  Patients believed any wait-listed individual who would gain life expectancy and quality of life compared with dialysis should have access to transplantation. Equity of access to transplantation for all patients and justice for those who would look after their transplant were considered important. A utilitarian rationale based on maximizing health gains from the allocation of a scarce resource to avoid "wastage," were rarely expressed. Organ allocation organisations need to seek input from patients who can articulate preferences for allocation and advocate for equity and justice in organ allocation.
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia. allison.tong@sydney.edu.au
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Michelle
authors.initials: M
authors.lastname: Irving
authors.forename: Steve
authors.initials: S
authors.lastname: Chadban
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.forename: Niamh
authors.initials: N
authors.lastname: Marren
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001315:Australia; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D014019:Tissue Donors; D014850:Waiting Lists; D055815:Young Adult