OBJECTIVES: There has been a persistent organ shortage, which forces priority setting to potential recipients. Because organ allocation is a highly normative decision task, it can be only legitimate if the general public is also involved in the decision-making. Therefore, public preferences for the allocation of deceased donor organs in Germany focusing on ethical principles of distributive justice were assessed.

METHODS: A discrete choice experiment (DCE) using a self-completed online questionnaire was performed. Based on a systematic review and focus group discussions, six attributes each with two-four levels were selected: life years gained after transplantation, quality of life after transplantation, chance for a further donor organ offer, age, registered donor and individual role in causing organ failure. A fractional factorial design with a total of 104 choice sets (13 blocks with 8 choice sets) without opt-out was conducted. Data were analyzed using conditional logit, mixed logit and latent class.

RESULTS: The final sample comprised 1,028 respondents. Choice decisions were significantly influenced by all attributes except chance for a further donor organ offer. The conditional logit demonstrates that a good quality of life after transplantation (Coef: 0.59; p<0.001), 25 year-old age (Coef: 0.32; p<0.001) and no individual role in causing organ failure (Coef: 0.37; p<0.001) had the greatest impact on choice decisions. Life years gained after transplantation and being a registered donor were less important. The latent class model identified four classes with preference heterogeneities.

CONCLUSIONS: The DCE reveals that the probability of success in terms of a good quality of life after transplantation and a younger patients’ age are most important in organ allocation for the public. Public preferences can help to inform policy to warrant socially responsible allocation systems and thus improve organ donation rates.