title: Patients' preferences in transplantation from marginal donors: results of a discrete choice experiment.
abstract: To increase the donor pool, the strategy of transplantation from "marginal" donors was developed though patients' preferences about these donors were insufficiently known. The preferences of patients registered on the waiting list or already transplanted in eight transplant teams covering four main organs (i.e., kidney, liver, heart, and lung) were evaluated using the discrete choice experiment method. In each left during 2 days, patients were interviewed on four scenarios. Of 178 eligible patients, 167 were interviewed; 40% accepted marginal graft in their own situation and 89% at least in one of the scenarios. Imagining urgent situations or rare profiles with difficult access to transplantation, respectively, 86% and 71% accepted these grafts. Most (76%) preferred to be informed about these grafts and 43% preferred to be involved in decision. The emergency [OR = 1.24; 95% CI: (1.06-1.45)] and the hazardousness [OR = 0.88; 95% CI: (0.78-0.99)] of the transplantation were factors independently associated with marginal graft acceptance. Most patients preferred to be informed and to be involved in the decision. Marginal grafts could be more accepted by patients in critical medical situations or perceiving their situation as critical. Physicians' practices in transplantation should be reconsidered taking into account individual preferences. This study was performed in a single country and thus reflects the cultural bias and practice thereof.
authors.affiliation: Public Health Ward: Quality and Risk Management, Paris left University Hospitals, Assistance Publique - Hôpitaux de Paris, Paris, France.|Doctoral School of Public Health (EDSP), Paris, France.
authors.forename: Sara
authors.identifier: http://orcid.org/0000-0001-7799-3053
authors.initials: S
authors.lastname: Kamran
authors.affiliation: Centre de Transplantation Hépatique, Pitié Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors.forename: Filomena
authors.initials: F
authors.lastname: Conti
authors.affiliation: Department of Health Administration, Institut de Recherche en Santé Publique, Université de Montréal, Montréal, QC, Canada.
authors.forename: Marie-Pascale
authors.initials: MP
authors.lastname: Pomey
authors.affiliation: UMR 1153 Epidemiology and Statistics Sorbonne Paris Cité left (CRESS), METHODS Team, INSERM, Paris, France.|Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Baron
authors.affiliation: Centre de Transplantation Hépatique, Pitié Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors.forename: Yvon
authors.initials: Y
authors.lastname: Calmus
authors.affiliation: Public Health Ward: Quality and Risk Management, Paris left University Hospitals, Assistance Publique - Hôpitaux de Paris, Paris, France.|UMR 1153 Epidemiology and Statistics Sorbonne Paris Cité left (CRESS), METHODS Team, INSERM, Paris, France.|Department of Public Health, Medical School, Paris Descartes University, Paris, France.
authors.forename: Gwenaëlle
authors.initials: G
authors.lastname: Vidal-Trecan
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D046148:Donor Selection / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000523:psychology; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods; D014850:Waiting Lists
keywords: information to provide to patient; marginal donor; marginal graft; patients’ preferences; shared decision