Decision-Making in Transplant Candidate Selection Committees: Frameworks and Other Considerations

Organ transplant selection committees are tasked with deciding whether patients seeking a transplant are medically and psychosocially appropriate to be placed on the waitlist. The selection process is obscure to patients and those outside of the institution. Currently, very limited standards exist for decision-making in selection committees, which could exacerbate inequities and disparities in the transplant process, a major concern among patients. Additionally, limited literature exists regarding decision-making in recipient selection committees. Evaluation of different decision-making frameworks and their factors may inform how current recipient selection committees should operate. There is no dearth of frameworks described for decision-making. The four group decision-making frameworks - autocratic, minority-control, majority-control, and consensus-based - were chosen for their ability to best represent different factors as they specifically relate to the transplant recipient selection process and were vetted against many other frameworks which were either deemed not applicable to transplant decision or not representative of the challenges faced in recipient selection. From the literature, we identified six themes that selection committees should be cognizant of during decision-making: reducing bias, balancing efficiency, confronting hierarchical structure, preventing groupthink, preventing group polarization, and using advocates and dissenters. These factors contribute to suboptimal outcomes and can be mitigated through a variety of factors. By creating uniform standards and policies and articulating them, increasing transparency of the decision-making processes in transplant selection, we may achieve more public trust in the system and more equity in the care of our patients.