Wisdom of the Crowd: Ensuring the justness and validity of group decision-making in solid organ transplant

The decision to accept or decline a patient for a lung, heart, liver, or kidney transplant is complex and high stakes, with significant consequences to both patient and society. In this area of high uncertainty, group decision-making can improve decision quality through pooled information, experience, and minimization of individuals' cognitive biases. However, it can also result in low-quality decisions if not executed properly. It is our experience that health professionals who participate in such important group decision-making may not be aware of its inherent vulnerabilities and therefore not be able to address them. In this perspective, we provide an overview of group decision-making as it applies to listing decisions in the practice of transplantation. We introduce the Cynefin framework as a foundation to build our understanding of complex decision-making and the rationale for why group rather than individual decisions are appropriate in this context. We then discuss the concept of Wisdom of the Crowd, followed by an overview of Groupthink. We end with evidence-based practical recommendations to improve the process of group decision-making, striving to maximize wisdom.