Rationing scarce organs for transplantation: healthcare provider perspectives on wait-listing and organ allocation

Authors

  • Allison Tong,

    Corresponding author
    1. Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
    • Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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  • Stephen Jan,

    1. Renal and Metabolic Division, The George Institute for Global Health, Sydney, NSW, Australia
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  • Germaine Wong,

    1. Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
    2. Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
    3. Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
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  • Jonathan C. Craig,

    1. Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
    2. Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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  • Michelle Irving,

    1. Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
    2. Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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  • Steven Chadban,

    1. Central Clinical School, Bosch Institute, The University of Sydney, Sydney, NSW, Australia
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  • Alan Cass,

    1. Renal and Metabolic Division, The George Institute for Global Health, Sydney, NSW, Australia
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  • Kirsten Howard

    1. Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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  • Conflict of interest: The authors have no conflict of interest to declare.

Corresponding author: Dr. Allison Tong, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, NSW 2145, Australia.

Tel.: +61 2 98451482; fax: +61 2 9845 1491; e-mail: allison.tong@sydney.edu.au

Abstract

Ongoing debate about how to maximize the benefit of scarce organs while maintaining equity of access to transplantation exists. This study aims to synthesize healthcare provider perspectives on wait-listing and organ allocation. MEDLINE, Embase, and PsycINFO were searched till February 21, 2011. Quantitative data were extracted, and a qualitative synthesis of the studies was conducted. Twenty studies involving 4254 respondents were included. We identified two goals underpinning healthcare provider preferences for organ allocation: (i) maximize clinical benefit (quality of life gains, patient survival, treatment adherence, and graft survival) and social outcomes (social support, productivity, and valuation); (ii) achieve equity (waiting time, patient preferences, access to live donation, and medical urgency). Maximizing clinical or social outcomes meant organs would be preferentially given to patients expected to achieve good transplant outcomes or wider social gain. Achieving equity meant all patients should have an equal chance of transplant, or patients deemed more urgent receive higher priority. A tension between equity and efficiency is apparent. Balanced against dimensions of efficiency were considerations to instill a degree of perceived fairness in organ allocation. Ongoing engagement with stakeholders is needed to enhance transparency, a reasonable balance between efficiency and equity, and avoid discrimination against specific populations.

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