title: Donor organ distribution according to urgency of need or outcome maximization in liver transplantation. A questionnaire survey among patients and medical staff.
abstract: Low donor rates in Germany cause a trade-off between equity in the distribution of chances for survival and efficiency in dead-donor liver transplantation. Public attitudes concerning the principles that should govern organ allocation are of interest. We performed a questionnaire-based study among patients and medical staff. 1826 of 2200 questionnaires were returned. 79.2%, 67.1%, and 24.4% patients wanted to accept liver transplantation for themselves if expected 1-year survival was 80%, 50%, and 20%, respectively. 57.7% affirmed 'averting immediate risk of death (urgency) is a more important criterion for organ allocation than expected long-term success' (P = 0.002 against indifference). The majority of medical staff took the opposite decision. 20.7%, 8.8%, and 21.2% of patients chose 50%, 33%, and 10% as lowest acceptable 5-year survival, respectively. 49.3% accepted a survival of <10%. Variables associated with preferring urgency over efficiency as criterion for allocation were age (OR 1.009; 95% CI: 1.000-1.017; female gender (OR 1.331; 95%CI 0.992-1.784); higher education (OR 0.881; 95%CI 0.801-0.969); and refusal of transplantation for oneself (OR 1.719; 95%CI 1.272-2.324). Most patients supported urgency-based liver allocation. Patients and medical staff would accept lower survival rates than the transplant community.
authors.affiliation: Klinik für Anästhesiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Katrin S
authors.initials: KS
authors.lastname: Umgelter
authors.forename: Moritz
authors.initials: M
authors.lastname: Tobiasch
authors.forename: Aida
authors.initials: A
authors.lastname: Anetsberger
authors.forename: Manfred
authors.initials: M
authors.lastname: Blobner
authors.forename: Stefan
authors.initials: S
authors.lastname: Thorban
authors.forename: Andreas
authors.initials: A
authors.lastname: Umgelter
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011795:Surveys and Questionnaires; D009927:Tissue and Organ Procurement
keywords: allocation; efficiency; liver transplantation; outcome; survey; urgency