Dao Van M, Lauerer M, Schätzlein V, Nagel E
Institut für Medizinmanagement und Gesundheitswissenschaften, Universität Bayreuth, Bayreuth.
Institut für Sportwissenschaft und Sport, FAU Erlangen-Nürnberg, Erlangen.
Gesundheitswesen. 2016 Jul;78(7):454-9. doi: 10.1055/s-0042-107668. Epub 2016 Jul 20.
According to the German Organ Transplantation Act, donor organs must be allocated with particular regard to chance of success and urgency. However, the objectives of these guiding criteria - the efficient use of available organs and meeting the most urgent need - are in conflict with each other, as success rate of transplantation (TX) ordinarily diminishes when urgency increases. Current allocation guidelines balance these criteria differently depending on the organ. This is only justified in part by medical reasons. Thus, further considerations are essential to develop consistent allocation rules. Therefore, a discussion on the stated trade-off considering the far-reaching consequences of such allocation decisions is indispensable. This also implies taking account of public preferences.
In this pilot study, preferences of 250 participants were assessed using a Discrete Choice Experiment. Choice-sets for the allocation of a donor organ included 2 patients, who were characterized by 3 success- and 2 urgency-based attributes. Data analysis was performed by Counting Analysis and Hierarchical Bayes estimation as well as Student's t-tests for subgroup analysis.
All attributes influenced allocation decisions significantly (p≤0.01). Both, patients with greater chance of success and higher urgency were preferred. As a whole, chance of success and urgency were equally important for the allocation of organs (53 and 47%, respectively). The importance of the success- and urgency-based criteria was quantified as follows: The post-TX 5-year probability of survival was weighted with 31%, the expected post-TX quality of life and the surgery survival rate with 11% each, the pre-TX 3-month mortality with 35% and the pre-TX quality of life with 12%. Subgroup analysis revealed significant differences.
The pilot study was successful in analyzing the balance of the guiding criteria chance of success and urgency without referring to a specific kind of organ. This type of results allows comparing current allocation rules and public preferences. These results could help decision makers to take into account public preferences developing organ-specific guidelines. A stronger involvement of citizens in decision making could gain confidence in transplantation medicine, increase the willingness to donate and potentially counteract the scarcity of organs and thereby the tragedy of the distributional conflict. Therefore the continuation of this project is advisable.
根据德国器官移植法案，捐赠器官的分配必须特别考虑成功几率和紧迫性。然而，这些指导标准的目标——有效利用可用器官并满足最迫切的需求——相互冲突，因为移植成功率通常会随着紧迫性的增加而降低。当前的分配指南根据器官的不同对这些标准进行了不同的权衡。这仅部分地基于医学原因。因此，需要进一步思考以制定一致的分配规则。所以，考虑此类分配决策的深远影响，对所述权衡进行讨论是必不可少的。这也意味着要考虑公众偏好。
在这项试点研究中，使用离散选择实验评估了250名参与者的偏好。捐赠器官分配的选择集包括2名患者，他们由3个基于成功和2个基于紧迫性的属性来描述。数据分析通过计数分析、分层贝叶斯估计以及用于亚组分析的学生t检验进行。
所有属性均对分配决策有显著影响（p≤0.01）。成功几率更高和紧迫性更高的患者都更受青睐。总体而言，成功几率和紧迫性在器官分配中同样重要（分别为53%和47%）。基于成功和紧迫性的标准的重要性量化如下：移植后5年生存率权重为31%，移植后预期生活质量和手术生存率各权重为11%，移植前3个月死亡率权重为35%，移植前生活质量权重为12%。亚组分析显示存在显著差异。
该试点研究成功地分析了成功几率和紧迫性这两个指导标准之间的权衡，而无需提及特定类型的器官。这种类型的结果有助于比较当前的分配规则和公众偏好。这些结果可以帮助决策者在制定器官特异性指南时考虑公众偏好。公民更多地参与决策可以增强对移植医学的信心，提高捐赠意愿，并有可能缓解器官短缺问题，从而避免分配冲突的悲剧。因此，建议继续开展该项目。
