Public preferences for the allocation of donor liver grafts for transplantation

To investigate the nature of public preferences in the allocation of donor liver grafts for transplantation a social conjoint analysis (CA) technique was developed for a questionnaire survey. A convenience sample of academic and non-academic employees of a British University were invited to participate in the survey. Respondents were presented with eight choice situations in which they were asked to allocate 100 donor liver grafts between two groups of 100 individuals in urgent need of a transplant. The groups of individuals differed in terms of the length of time spent waiting, the life years gained following transplantation, age, personal responsibility for their illness and whether they were primary or re-transplant candidates. Only two respondents (0.7%) consistently chose to give all of the donor organs to the group of individuals with the highest expected length of survival whilst seven respondents (2%) exhibited strict egalitarian preferences, allocating equal numbers of donor organs to both groups irrespective of their characteristics. The vast majority of respondents indicated that they would be prepared to sacrifice some gain in the efficiency of the transplantation programme for an increase in equity or fairness in the allocation of donor livers. Using social CA it was possible to establish the relative weight attached to each characteristic in determining individual's allocation decisions.