M HOWELL1,2, G WONG1,2,3, M SYPEK4, K HOWARD1, J CRAIG1,2, P CLAYTON4,5, S MCDONALD4,5
1School of Public Health, University Of Sydney, University Of Sydney, Australia, 2Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia, 3Centre for Transplant and Renal Research, Westmead Hospital, , Westmead, Australia, 4Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, Australia, 5Central and Northern Adelaide Renal and Transplantation Service and Department of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
Aim: To elicit community preferences for principles guiding the allocation of kidneys from deceased donors.
Background: Deceased donor organs are scarce, community resources, therefore the principles underpinning organ allocation should reflect societal values.
Method: A best-worst scaling survey including 29 principles was used to elicit preferences from a community sample. Participants were shown 10 questions, each presenting four principles and asked to choose the most and least important. Preference scores were estimated by multinomial logit regression with point estimates adjusted to a scale of 0 to 1 for ease of interpretation.
Results: The survey was completed by 1082 adults, (median age 52 years, 50% male, and 75% residing in metropolitan areas). The five most important principles that underpinned community values for guiding allocation were length of time on the wait-list (point estimate preference score 1.0 [95% CI 0.94,1.06]), equity for socially disadvantaged (0.99 [0.93,1.05]), priority to the sickest (0.96[0.90, 1.02]), gender equity (0.96 [0.90, 1.02]), and recipient/donor compatibility (0.93 [0.87, 0.99). These were more important than principles of efficiency including matching the predicted survival of organs with recipients for both long (0.74 [0.68, 0.80]), and short (0.19 [0.13, 0.25]) predicted survival and age matching young to young (0.49 [0.43, 0.56]). The least important principles were giving priority to those residing in the same State as the donor, the aged and registered donors with preference scores all less than 0.1. There was some heterogeneity in preferences according to gender, self-reported knowledge and being a registered donor.
Conclusion: The community values allocation principles that favour equity over those prioritising efficiency, these preferences should be considered when redesigning the systems that determine deceased donor kidney allocation.
Dr Martin Howell is Research Fellow in Health Economics in the Sydney School of Public Health at the University of Sydney. His research focuses on applied health economics research predominantly in the areas economic evaluations of health interventions and the assessment of preferences using discrete choice to address complex health research questions. His PhD project involved the novel application of a Best Worst Scaling survey to elicit kidney transplant patient preferences for outcomes after transplantation. Other areas of expertise, include the development of clinical practice guidelines have worked with KHA-CARI clinical practice guidelines group since 2008.