Defining a Willingness-to-transplant Threshold in an Era of Organ Scarcity: Simultaneous Liver-kidney Transplant as a...

Area of Science:

• Transplantation medicine
• Health economics
• Bioethics

Background:

• Organ scarcity remains a critical barrier in solid organ transplantation.
• Advancements in managing end-stage organ disease increase demand for multi-organ transplants.
• Current multi-organ transplant allocation prioritizes recipients, raising ethical concerns about equity and utility.

Purpose of the Study:

• To examine the ethical tension between equity and utility in multi-organ transplant allocation.
• To introduce a novel metric, the willingness-to-transplant (WTT) threshold, for evaluating organ allocation strategies.
• To use simultaneous liver and kidney (SLK) transplantation as a case study.

Main Methods:

• Adaptation of the health economics willingness-to-pay threshold to solid organ transplantation.
• Development and application of the willingness-to-transplant (WTT) threshold.
• Synthesis of utility and equity perspectives to evaluate SLK allocation strategies.

Main Results:

• The WTT threshold provides a framework for evaluating multi-organ transplant allocation.
• Demonstration of how the WTT threshold can assess different SLK allocation strategies.
• Integration of utility and equity considerations into a unified metric.

Conclusions:

• The WTT threshold simplifies SLK allocation decisions to a question of minimum required benefit from a donor organ.
• This framework aids in developing rational allocation systems for SLK transplants.
• The proposed framework is applicable to other multi-organ transplant scenarios.