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Balancing urgency, age and quality of life in organ allocation decisions—what would you do?: a survey
  1. J E Stahl1,2,
  2. A C Tramontano1,
  3. J S Swan1,3,
  4. B J Cohen4,5
  1. 1
    Massachusetts General Hospital, Institute for Technology Assessment, Boston, Massachusetts, USA
  2. 2
    Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3
    Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4
    Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts, USA
  5. 5
    Division of Clinical Decision Making, Informatics and Telemedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. James E Stahl, Massachusetts General Hospital Institute for Technology Assessment, 101 Mermac St, 10th floor, Boston, MA 02114, USA; James{at}mgh-ita.org; jstahl{at}partners.org

Abstract

Purpose: Explore public attitudes towards the trade-offs between justice and medical outcome inherent in organ allocation decisions.

Background: The US Task Force on Organ Transplantation recommended that considerations of justice, autonomy and medical outcome be part of all organ allocation decisions. Justice in this context may be modeled as a function of three types of need, related to age, clinical urgency, and quality of life.

Methods: A web-based survey was conducted in which respondents were asked to choose between two hypothetical patients who differed in clinical urgency (time to death <1 year), age, pretransplant and post-transplant quality of life, and life expectancy.

Results: A pool of 1600 people were notified via email about the survey; 623 (39%) responded. Respondents preferred giving organs to younger people up to an age difference of <15.4 years (SD 18) and more clinically urgent people up to a difference in urgency of <2.54 months (SD 3). Priority varied with the quality of life of the worst-off patient and the relative status of the patients. If both had worse than average quality of life, respondents preferred the better-off patient. When both had better than average quality of life, they preferred the worse-off patient. In analysis according to age versus clinical urgency, the older the patient, the more urgency needed to receive priority. In quality of life versus clinical urgency, the better the control’s quality of life, the more urgency the competing patient required. The worse the patient’s post-transplant outcome, the more urgency needed to receive priority.

Conclusions: It appears that clinical urgency is only one of many factors influencing attitudes about allocation decisions and that respondents may invoke different principles of fairness depending the relative clinical status of patients.

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Footnotes

  • Competing interests: None.

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