02452nas a2200229   4500000000100000008004100001100001200042700001400054700001200068700001400080700001300094700001500107700001400122700001400136700001600150245011200166250001500278300000700293490000700300520186900307020004602176       2012                            d1 aWong G.1 aCass Alan1 aTong A.1 aMarren N.1 aCraig J.1 aChadban S.1 aIrving M.1 aHoward K.1 aJan Stephen00aPatient preferences for the allocation of deceased donor kidneys for transplantation: a mixed methods study  a2012/04/19  a180 v133 a<p>
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.
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