Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany; Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Str. 7, 30159, Hannover, Germany.
Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Str. 7, 30159, Hannover, Germany; Department of General, Visceral and Transplant Surgery, Medical University Graz, Auenbruggerplatz 29, 8036, Graz, Austria; Transplant Center Graz, Medical University Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
Soc Sci Med. 2021 Oct;287:114360. doi: 10.1016/j.socscimed.2021.114360. Epub 2021 Sep 3.
This study aimed to assess public preferences for the allocation of donor organs in Germany with the focus on ethical principles of distributive justice. We performed a discrete choice experiment (DCE) using a self-completed online questionnaire. Based on a systematic review and focus group discussions, six attributes, each with two-four levels, were selected (corresponding principle of distributive justice in brackets), including (1) life years gained after transplantation (principle of distributive justice: effectiveness/benefit - utilitarianism), (2) quality of life after transplantation (effectiveness/benefit - utilitarianism), (3) chance for a further donor organ offer (principle of distributive justice: medical urgency - favouring the worst-off), (4) age (medical and social risk factors: sociodemographic status), (5) registered donor (principle of distributive justice: value for society), and (6) individual role in causing organ failure (principle of distributive justice: own fault). Each respondent was presented with eight choice sets and asked to choose between two hypothetical patients without an opt-out. Data were analysed using conditional logit, mixed logit and latent class models. The final sample comprised 1028 respondents. Choice decisions were significantly influenced by all attributes except chance for a further donor organ offer. The attributes of good quality of life after transplantation, younger age, and no individual role in causing organ failure had the greatest impact on choice decisions. Life years gained after transplantation and being a registered donor were less important for the public. The latent class model identified four classes with preference heterogeneities. Respondents preferred to allocate deceased donor organs by criteria related to effectiveness/benefit, whereas medical urgency was of minor importance. Therefore, a public propensity for a rational, utilitarian, ethical model of allocation could be identified. Public preferences can help to inform policy to warrant socially responsible allocation systems and thus improve organ donation rates.
本研究旨在评估德国公众对器官分配的偏好，重点是分配正义的伦理原则。我们使用自我完成的在线问卷进行了离散选择实验（DCE）。基于系统评价和焦点小组讨论，选择了六个属性，每个属性有两个到四个水平（括号内为相应的分配正义原则），包括（1）移植后获得的生命年（分配正义原则：有效性/效益 - 功利主义），（2）移植后的生活质量（有效性/效益 - 功利主义），（3）进一步获得供体器官的机会（分配正义原则：医疗紧迫性 - 优待最差的），（4）年龄（医疗和社会风险因素：社会人口地位），（5）登记的供体（分配正义原则：对社会的价值），和（6）导致器官衰竭的个人作用（分配正义原则：自己的过错）。每个受访者都被呈现了八个选择集，并被要求在没有选择退出的情况下在两个假设的患者之间进行选择。使用条件逻辑回归、混合逻辑回归和潜在类别模型对数据进行分析。最终样本包括 1028 名受访者。选择决策受到除了进一步获得供体器官的机会外的所有属性的显著影响。生活质量好、年龄较小和个人在导致器官衰竭方面没有作用的属性对选择决策的影响最大。移植后获得的生命年和成为登记供体对公众来说则不太重要。潜在类别模型确定了四个偏好异质性的类别。受访者更倾向于根据与有效性/效益相关的标准来分配已故供体器官，而医疗紧迫性则不太重要。因此，可以确定公众对一种合理、功利主义、伦理分配模式的倾向。公众的偏好可以帮助为有社会责任感的分配系统提供信息，从而提高器官捐赠率。
