Donor organ distribution according to urgency of need or outcome maximization in liver transplantation. A questionnaire survey among patients and medical staff.

Umgelter, Katrin S; Tobiasch, Moritz; Anetsberger, Aida; Blobner, Manfred; Thorban, Stefan; Umgelter, Andreas

doi:10.1111/tri.12512

2015

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Title:: Donor organ distribution according to urgency of need or outcome maximization in liver transplantation. A questionnaire survey among patients and medical staff.
Document type:: Journal Article; Article
Author(s):: Umgelter, Katrin S; Tobiasch, Moritz; Anetsberger, Aida; Blobner, Manfred; Thorban, Stefan; Umgelter, Andreas
Abstract:: Low donor rates in Germany cause a trade-off between equity in the distribution of chances for survival and efficiency in dead-donor liver transplantation. Public attitudes concerning the principles that should govern organ allocation are of interest. We performed a questionnaire-based study among patients and medical staff. 1826 of 2200 questionnaires were returned. 79.2%, 67.1%, and 24.4% patients wanted to accept liver transplantation for themselves if expected 1-year survival was 80%, 50%, and 20%, respectively. 57.7% affirmed 'averting immediate risk of death (urgency) is a more important criterion for organ allocation than expected long-term success' (P = 0.002 against indifference). The majority of medical staff took the opposite decision. 20.7%, 8.8%, and 21.2% of patients chose 50%, 33%, and 10% as lowest acceptable 5-year survival, respectively. 49.3% accepted a survival of <10%. Variables associated with preferring urgency over efficiency as criterion for allocation were age (OR 1.009; 95% CI: 1.000-1.017; female gender (OR 1.331; 95%CI 0.992-1.784); higher education (OR 0.881; 95%CI 0.801-0.969); and refusal of transplantation for oneself (OR 1.719; 95%CI 1.272-2.324). Most patients supported urgency-based liver allocation. Patients and medical staff would accept lower survival rates than the transplant community.
Journal title abbreviation:: Transpl Int
Year:: 2015
Journal volume:: 28
Journal issue:: 4
Pages contribution:: 448-54
Language:: eng
Fulltext / DOI:: doi:10.1111/tri.12512
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/25557453
Print-ISSN:: 0934-0874
TUM Institution:: Chirurgische Klinik und Poliklinik; II. Medizinische Klinik und Poliklinik (Gastroenterologie); Klinik für Anästhesiologie (DHM)
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