Should We Use Behavioural Predictions in Organ Allocation?

Area of Science:

• Medical Ethics
• Transplant Surgery
• Health Psychology

Background:

• Medical predictions aid resource allocation, including patient survival likelihood.
• Patient behavior predictions, such as medication adherence and alcohol use, are debated for use in organ transplant prioritization.

Purpose of the Study:

• To explore ethical arguments for and against using patient behavioral predictions in organ allocation.
• To gather empirical evidence on public acceptance of behavioral predictions in liver transplant prioritization.

Main Methods:

• Literature review of ethical arguments surrounding behavioral predictions in healthcare.
• Online survey of 172 UK adults assessing acceptance of various prediction factors for liver allocation.
• Experimental design randomizing participants to evaluate deprioritization based on predicted adherence.

Main Results:

• A majority of participants supported using predictions of higher medication adherence and lower alcohol use for liver allocation.
• Most participants found deprioritizing a patient based on predicted medication adherence acceptable.
• No significant ethical difference was found between behavioral and non-behavioral predictions in current organ allocation practices.

Conclusions:

• Empirical evidence suggests public support for incorporating behavioral predictions, particularly regarding adherence and substance use, into organ allocation decisions.
• Behavioral predictions in organ allocation may be ethically justifiable and align with existing medical prediction practices.
• Further research is warranted to refine the ethical framework for utilizing behavioral predictions in transplant prioritization.