Browning C J, Thomas S A
School of Public Health, La Trobe University, Victoria, Australia.
Soc Sci Med. 2001 Mar;52(6):853-61. doi: 10.1016/s0277-9536(00)00187-8.
This paper is concerned with community values and preferences in organ transplantation allocation decisions. With recent trends in organ shortages, transplant teams face difficult allocation decisions amongst increasing numbers of "worthy" potential recipients. It is argued that the debate about these decisions ought to be informed in part by a systematic knowledge of prevailing community standards. A community sample of 238 adults (140 women and 98 men, with a mean age of 47.0 years) completed a questionnaire concerning which factors ought to affect recipient priority for transplantation. Longer waiting time, better prognosis, younger age and being a parent were the most frequently selected criteria for organ allocation decisions. The participants also rank ordered 16 potential recipients presented in the form of case scenarios in terms of priority for transplantation. The 16 case scenarios were constructed from a factorial combination of four variables: age of recipient (young vs old); the time the recipient had been on a waiting list (long vs short); recipient prognosis (excellent vs fair); and parental status (children vs no children). It was found that one case scenario involving a young parent with an excellent prognosis and long waiting time was ranked first by 75.2% of all participants. Analysis revealed that transplant recipient age and prognosis were the most influential factors in determining the priority rankings for organ allocation. The study has demonstrated that judgement and decision analysis procedures can be used to elicit community values and preferences about complex resource allocation decisions.
本文关注器官移植分配决策中的社区价值观和偏好。随着近期器官短缺的趋势，移植团队在越来越多“值得救治”的潜在受者中面临艰难的分配决策。有人认为，关于这些决策的辩论部分应该基于对现行社区标准的系统了解。对238名成年人（140名女性和98名男性，平均年龄47.0岁）的社区样本进行了问卷调查，询问哪些因素应该影响移植受者的优先顺序。等待时间更长、预后更好、年龄更小以及身为父母是器官分配决策中最常被选择的标准。参与者还对以案例情景形式呈现的16名潜在受者按照移植优先顺序进行了排序。这16个案例情景由四个变量的因子组合构建而成：受者年龄（年轻与年老）；受者在等待名单上的时间（长与短）；受者预后（优秀与一般）；以及父母身份（有孩子与无孩子）。结果发现，一个涉及预后优秀、等待时间长的年轻父母的案例情景被75.2%的参与者排在首位。分析表明，移植受者的年龄和预后是决定器官分配优先顺序排名的最有影响力的因素。该研究表明，判断和决策分析程序可用于引出社区对复杂资源分配决策的价值观和偏好。
