School of Public Health, The University of Sydney, Sydney, NSW, Australia.
Nephrol Dial Transplant. 2013 Aug;28(8):2187-93. doi: 10.1093/ndt/gft208. Epub 2013 Jun 5.
Solid organ transplantation is the treatment of choice for those with organ failure, but suitable organs are a limited community resource. Little is known about community preferences for the allocation of those organs. We aimed to determine community preferences for organ allocation and reasons for their choices.
Participants were recruited from the community in four states in Australia. In focus groups, they identified and discussed attributes that they believed were important for allocating organs to potential recipients. Transcripts were analysed thematically.
Thirteen focus groups with 114 participants were conducted. Four major themes emerged: (i) saving and improving the lives; (ii) lowering the risk of lost opportunities; (iii) fairness and (iv) accountability. While happy to discuss general principles, many were not comfortable making organ allocation decisions and were happy to defer to health professionals; this reticence tended to disappear when discussing the use of their own organs.
Participants wanted to save as many lives as possible as well as lower the risk of lost opportunities for those on the waiting list by maximizing the chances of success of every donation. A rational utilitarian ethical model of organ allocation, therefore, appeared to be the dominant framework adopted by the community. Key considerations were compatibility, high chance of peri-operative survival and favouring those with positive lifestyle and self-management choices. Communication between the transplant community and general community about organ allocation could be undertaken to create trust and shared understanding, which may ultimately increase organ donation rates in the future.
对于那些器官衰竭的患者来说，实体器官移植是治疗的首选方法，但合适的器官是一种有限的社区资源。对于器官分配的社区偏好，人们知之甚少。我们旨在确定社区对器官分配的偏好以及他们选择的原因。
参与者从澳大利亚四个州的社区招募。在焦点小组中，他们确定并讨论了他们认为对潜在受者器官分配重要的属性。对转录本进行了主题分析。
进行了 13 次焦点小组讨论，共 114 名参与者。出现了四个主要主题：（i）挽救和改善生命；（ii）降低错失机会的风险；（iii）公平；（iv）问责制。虽然乐意讨论一般原则，但许多人对做出器官分配决定感到不舒服，愿意听从卫生专业人员的意见；当讨论使用自己的器官时，这种犹豫往往会消失。
参与者希望通过最大限度地提高每次捐赠的成功率，尽可能多地挽救生命，并降低等待名单上的人错失机会的风险。因此，器官分配的理性功利主义伦理模式似乎是社区采用的主要框架。关键考虑因素是兼容性、围手术期生存的高几率以及对积极生活方式和自我管理选择的偏好。可以在移植社区和一般社区之间就器官分配进行沟通，以建立信任和共识，这可能最终会提高未来的器官捐赠率。
