Transplant Physicians’ Preferences in Deceased Organ Allocation: A Pilot Discrete Choice Experiment

OBJECTIVES: Deceased donor organs available for transplantation are a scarce resource since the beginning of transplantation medicine, resulting in the demand far exceeding the supply in every country worldwide. This study aimed to assess transplant physicians’ preferences guiding the allocation of deceased donor organs in Germany. We performed a pilot discrete choice experiment (DCE) using a paper-pencil questionnaire.

METHODS: Based on a systematic review and focus groups, five attributes, each with two to four levels, were selected. 1) life years gained after transplantation (+5, +10, +15 years), 2) quality of life after transplantation (bad, moderate, good), 3) chance for a further donor organ offer (25%, 50%, 75%), 4) age (25, 40, 55, 70 years old), and 5) registered donor (yes, no). Each respondent was presented with eight choice sets and asked to choose between two hypothetical patients without an opt-out. Data were analyzed using conditional logit model and subgroup analysis.

RESULTS: The sample comprised 57 respondents, including 22 conservative and 35 surgical transplant physicians (period: 11/2021-03/2022). Choice decisions were significantly influenced by all attributes except 50% chance for a further donor organ offer. The greatest impact on choice decisions had a young age (25 years: β=2.02, p<0.001), a good quality of life (β=1.92, p<0.001) and more additional life years gained after transplantation (+15 years: β=1.80, p<0.001), while being a registered donor (β=0.62, p<0.001) had less but still significant influence. A higher chance for a further donor organ offer (indicating as low medical urgency) was associated with negative impact (75%: β=-0.37, p<0.070).

CONCLUSIONS: This DCE provides useful insights into the key stakeholder perspective: Transplant physicians preferred to allocate deceased donor organs by criteria related to success, whereas medical urgency was of minor importance. Therefore, their opinions are substantial in revising the current organ allocation policy in Germany.