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Iida T, Kawata K, Nakabayashi M. The citizen preferences-positive externality trade-off: A survey study of COVID-19 vaccine deployment in Japan. SSM Popul Health 2022; 19:101191. [PMID: 35992967 PMCID: PMC9381943 DOI: 10.1016/j.ssmph.2022.101191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Medicine is a scarce resource and a public good that benefits others by bettering patients’ health. COVID-19 vaccines in shortage are, 1) a scarce resource and 2) a public good with the positive externality of building herd immunity. These features are expected to drive citizens’ attitudes in opposite directions, exclusionist and inclusionist, respectively. Scarcity would drive citizens’ exclusionism, while the positive externality might mitigate exclusionism. Setting and design We recruited 15,000 Japanese adults and asked them to rank, in the context of a COVID-19 vaccine shortage, the deservingness of hypothetical vaccine recipients who differed according to 1) citizenship status, 2) visa type and duration of stay (if foreign), 3) occupation, 4) age, 5) whether they lived with a child, and 6) whether they lived with an elderly individual. Citizenship options were Japanese, Chinese, Taiwanese, South Korean, American, or European. The occupations were healthcare, education, other employed, self-employed, or not employed. The 6 attributes were randomly combined, and respondents were shown 3 hypothetical vaccine recipients: one was Japanese, and the others were foreigners. Treatments First, through a conjoint design, we created hypothetical vaccine recipients whose attributes were randomized except for the benchmark citizenship, Japanese national. Second, we randomly presented two scenarios for vaccination payments: 1) billed at cost or 2) fully subsidized by the government. Results 1) Whether the vaccines were billed at cost or fully subsidized did not affect the rankings of deservingness. 2) Japanese citizenship was prioritized. 3) The penalty for being a foreigner was higher for individuals from nations with which Japan has geopolitical tensions. 4) Working in health or education reduced the penalty on foreigners, indicating that the positive externality related to occupation amplifies the positive externality associated with vaccination and mitigates exclusionist attitudes. Conclusions The positive occupational externalities that amplify the positive externality of vaccination substantially allay the foreigner penalty.
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Abstract
Organs for transplantation are a scarce resource. Markedly, the transplant community's primary challenge is the stark disparity between the number of patients awaiting deceased donor organ transplants and the rate at which organs become available. However, the allocation of a limited number of organs poses another constant challenge: maintaining an equilibrium between renal transplant utility and equity, that is, striking a balance between the utilitarian argument of medical efficiency and the principle of equity. In this comprehensive overview, the authors delve into the challenge of maintaining an acceptable balance between equity and efficiency and elaborate on some of the factors that might inform a decisionmaker's evaluation of the extent to which a given allocation scheme is efficient or equitable.
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Oedingen C, Bartling T, Schrem H, Mühlbacher AC, Krauth C. Public preferences for the allocation of donor organs for transplantation: A discrete choice experiment. Soc Sci Med 2021; 287:114360. [PMID: 34507218 DOI: 10.1016/j.socscimed.2021.114360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/02/2021] [Accepted: 08/31/2021] [Indexed: 12/23/2022]
Abstract
This study aimed to assess public preferences for the allocation of donor organs in Germany with the focus on ethical principles of distributive justice. We performed a discrete choice experiment (DCE) using a self-completed online questionnaire. Based on a systematic review and focus group discussions, six attributes, each with two-four levels, were selected (corresponding principle of distributive justice in brackets), including (1) life years gained after transplantation (principle of distributive justice: effectiveness/benefit - utilitarianism), (2) quality of life after transplantation (effectiveness/benefit - utilitarianism), (3) chance for a further donor organ offer (principle of distributive justice: medical urgency - favouring the worst-off), (4) age (medical and social risk factors: sociodemographic status), (5) registered donor (principle of distributive justice: value for society), and (6) individual role in causing organ failure (principle of distributive justice: own fault). Each respondent was presented with eight choice sets and asked to choose between two hypothetical patients without an opt-out. Data were analysed using conditional logit, mixed logit and latent class models. The final sample comprised 1028 respondents. Choice decisions were significantly influenced by all attributes except chance for a further donor organ offer. The attributes of good quality of life after transplantation, younger age, and no individual role in causing organ failure had the greatest impact on choice decisions. Life years gained after transplantation and being a registered donor were less important for the public. The latent class model identified four classes with preference heterogeneities. Respondents preferred to allocate deceased donor organs by criteria related to effectiveness/benefit, whereas medical urgency was of minor importance. Therefore, a public propensity for a rational, utilitarian, ethical model of allocation could be identified. Public preferences can help to inform policy to warrant socially responsible allocation systems and thus improve organ donation rates.
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Affiliation(s)
- Carina Oedingen
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany; Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Str. 7, 30159, Hannover, Germany.
| | - Tim Bartling
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany; Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Str. 7, 30159, Hannover, Germany.
| | - Harald Schrem
- Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Str. 7, 30159, Hannover, Germany; Department of General, Visceral and Transplant Surgery, Medical University Graz, Auenbruggerplatz 29, 8036, Graz, Austria; Transplant Center Graz, Medical University Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
| | - Axel C Mühlbacher
- Institute of Health Economics and Health Care Management, Hochschule Neubrandenburg, Brodaer Str. 2, 17033, Neubrandenburg, Germany; Duke Department of Population Health Sciences and Duke Global Health Institute, Duke University, 215 Morris Street, Durham, NC, 27701, USA.
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany; Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Str. 7, 30159, Hannover, Germany.
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The Triage Stalemate During the Coronavirus Disease 2019 Pandemic: Losing Fairness to Ethical Paralysis. Crit Care Med 2020; 48:e1380-e1381. [PMID: 32826433 PMCID: PMC7467035 DOI: 10.1097/ccm.0000000000004567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Senanayake S, Graves N, Healy H, Baboolal K, Barnett A, Sypek MP, Kularatna S. Deceased donor kidney allocation: an economic evaluation of contemporary longevity matching practices. BMC Health Serv Res 2020; 20:931. [PMID: 33036621 PMCID: PMC7547436 DOI: 10.1186/s12913-020-05736-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Matching survival of a donor kidney with that of the recipient (longevity matching), is used in some kidney allocation systems to maximize graft-life years. It is not part of the allocation algorithm for Australia. Given the growing evidence of survival benefit due to longevity matching based allocation algorithms, development of a similar kidney allocation system for Australia is currently underway. The aim of this research is to estimate the impact that changes to costs and health outcomes arising from 'longevity matching' on the Australian healthcare system. METHODS A decision analytic model to estimate cost-effectiveness was developed using a Markov process. Four plausible competing allocation options were compared to the current kidney allocation practice. Models were simulated in one-year cycles for a 20-year time horizon, with transitions through distinct health states relevant to the kidney recipient. Willingness to pay was considered as AUD 28000. RESULTS Base case analysis indicated that allocating the worst 20% of Kidney Donor Risk Index (KDRI) donor kidneys to the worst 20% of estimated post-transplant survival (EPTS) recipients (option 2) and allocating the oldest 25% of donor kidneys to the oldest 25% of recipients are both cost saving and more effective compared to the current Australian allocation practice. Option 2, returned the lowest costs, greatest health benefits and largest gain to net monetary benefits (NMB). Allocating the best 20% of KDRI donor kidneys to the best 20% of EPTS recipients had the lowest expected incremental NMB. CONCLUSION Of the four longevity-based kidney allocation practices considered, transplanting the lowest quality kidneys to the worst kidney recipients (option 2), was estimated to return the best value for money for the Australian health system.
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Affiliation(s)
- Sameera Senanayake
- Australian Center for Health Service Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia.
| | - Nicholas Graves
- Australian Center for Health Service Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Helen Healy
- Royal Brisbane Hospital for Women, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Keshwar Baboolal
- Royal Brisbane Hospital for Women, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Adrian Barnett
- Australian Center for Health Service Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Matthew P Sypek
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, SA, Australia
| | - Sanjeewa Kularatna
- Australian Center for Health Service Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
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Oedingen C, Bartling T, Dierks ML, Mühlbacher AC, Schrem H, Krauth C. Public preferences for the allocation of donor organs for transplantation: Focus group discussions. Health Expect 2020; 23:670-680. [PMID: 32189453 PMCID: PMC7321724 DOI: 10.1111/hex.13047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Deceased donor organs are scarce resources because of a large supply-and-demand mismatch. This scarcity leads to an ethical dilemma, forcing priority-setting of how these organs should be allocated and whom to leave behind. OBJECTIVE To explore public preferences for the allocation of donor organs in regard to ethical aspects of distributive justice. METHODS Focus groups were facilitated between November and December 2018 at Hannover Medical School. Participants were recruited locally. Transcripts were assessed with content analysis using the deductive framework method. All identified and discussed criteria were grouped according to the principles of distributive justice and reported following the COREQ statement. RESULTS Six focus groups with 31 participants were conducted. Overall, no group made a final decision of how to allocate donor organ; however, we observed that not only a single criterion/principle but rather a combination of criteria/principles is relevant. Therefore, the public wants to allocate organs to save as many lives as possible by both maximizing success for and also giving priority to urgent patients considering the best compatibility. Age, waiting time, reciprocity and healthy lifestyles should be used as additional criteria, while sex, financial status and family responsibility should not, based on aspects of equality. CONCLUSIONS All participants recognized the dilemma that prioritizing one patient might cause another one to die. They discussed mainly the unclear trade-offs between effectiveness/benefit and medical urgency and did not establish an agreement about their importance. The results suggest a need of preference studies to elucidate public preferences in organ allocation.
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Affiliation(s)
- Carina Oedingen
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.,Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Tim Bartling
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.,Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Marie-Luise Dierks
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Axel C Mühlbacher
- Institute of Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany.,Duke Department of Population Health Sciences and Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Harald Schrem
- Department of General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria.,Transplant Center Graz, Medical University Graz, Graz, Austria
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.,Center for Health Economics Research Hannover (CHERH), Hannover, Germany
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Lee D, Kanellis J, Mulley WR. Allocation of deceased donor kidneys: A review of international practices. Nephrology (Carlton) 2019; 24:591-598. [DOI: 10.1111/nep.13548] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Darren Lee
- Department of Renal MedicineEastern Health Melbourne Victoria Australia
- Eastern Health Clinical SchoolMonash University Melbourne Victoria Australia
- Department of NephrologyAustin Health Melbourne Victoria Australia
| | - John Kanellis
- Department of NephrologyMonash Medical Centre Melbourne Victoria Australia
- Centre for Inflammatory Diseases, Department of MedicineMonash University Melbourne Victoria Australia
| | - William R Mulley
- Department of NephrologyMonash Medical Centre Melbourne Victoria Australia
- Centre for Inflammatory Diseases, Department of MedicineMonash University Melbourne Victoria Australia
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Systematic Review of Public Preferences for the Allocation of Donor Organs for Transplantation: Principles of Distributive Justice. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:475-489. [DOI: 10.1007/s40271-019-00363-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Countries in Europe and in the USA are proclaiming their need for an objective allocation system that can cope with distribution of a scarce resource in a changing environment of an older donor and recipient population and of an increased number of patients on mechanical circulatory support, whose prospects are increasing. RECENT FINDINGS The current heart allocation systems in Eurotransplant, France and the USA are all urgency tier systems, where within the same tier a first-come, first-served principle is applied. Both Eurotransplant and France are developing new heart allocation schemes that hinge on a benefit principle, thereby combining the prospects of patients after transplantation with their expected clinical course while on the waiting list. In the USA, a different approach has been chosen for their new allocation scheme, as the medical urgency of the patient is the driving force behind the proposal. SUMMARY Policies to ensure a fair, efficient, and medically optimal matching of donor organs and recipients are continually evaluated and refined. The ethical cornerstone of each organ allocation policy in the described countries is the effort of balancing justice and utility.
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Wu DA, Watson CJ, Bradley JA, Johnson RJ, Forsythe JL, Oniscu GC. Global trends and challenges in deceased donor kidney allocation. Kidney Int 2017; 91:1287-1299. [DOI: 10.1016/j.kint.2016.09.054] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/12/2016] [Accepted: 09/28/2016] [Indexed: 01/23/2023]
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Smits JM. Actual situation in Eurotransplant regarding high urgent heart transplantation. Eur J Cardiothorac Surg 2012; 42:609-11. [DOI: 10.1093/ejcts/ezs424] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Community preferences for the allocation of solid organs for transplantation: a systematic review. Transplantation 2010; 89:796-805. [PMID: 20090570 DOI: 10.1097/tp.0b013e3181cf1ee1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Organs for transplantation are a scarce community resource but community preferences and how they are incorporated into allocation policies are unclear. This systematic review aimed to ascertain community preferences for organ allocation and the principles underpinning these preferences. METHODS Medline, Embase, PsycINFO, EconLit, and gray literature databases were searched. Quantitative data were extracted, and a qualitative textual synthesis of the results and conclusions reported in each included study was performed. RESULTS Fifteen studies involving more than 5563 respondents were included. Seven themes describing community preferences for organ allocation were identified: (1) maximum benefit, to achieve maximum health gain in recipient survival and quality of life; (2) social valuation, to base preferences on societal gain; (3) moral deservingness, to consider the "worthiness" of recipients based on their social standing and lifestyle decisions; (4) prejudice, to make a judgement based on personal ideologic viewpoints; (5) "fair innings," to provide an organ preferentially to the younger recipient giving opportunity for a "normal" life span and to those waiting for a first organ rather than a retransplant; (6) "first come, first served," to allocate the organ to recipients wait-listed the longest; and (7) medical urgency, to allocate based on illness severity and saving life. CONCLUSIONS Community preferences for organ allocation hinge on a complex balance of efficiency, social valuation, morality, fairness, and equity principles. Being a community-held resource, effective ways to identify and incorporate community preferences into allocation algorithms for solid organ transplantation are warranted.
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Affiliation(s)
- P Cochat
- Département de pédiatrie, Inserm U499, hôpital Edouard-Herriot, université Claude-Bernard, 69437 Lyon cedex 03, France.
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van den Hout WB, Smits JMA, Deng MC, Hummel M, Schoendube F, Scheld HH, Persijn GG, Laufer G. The heart-allocation simulation model: a tool for comparison of transplantation allocation policies1. Transplantation 2003; 76:1492-7. [PMID: 14657692 DOI: 10.1097/01.tp.0000092005.95047.e9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous studies have investigated prognostic factors for the survival of transplant candidates waiting for a donor organ, but little is known about the impact of allocation policies on waiting list outcome. Simulation models would allow a comparison of different policies for allocating donor hearts on pretransplant outcome. METHODS A model was built for the Eurotransplant waiting list for heart transplantation. Survival and delisting distributions were estimated from the Eurotransplant transplant candidate inflow between 1995 and 2000 (n=7,142). Other characteristics were obtained directly from the transplant candidate inflow of 1999 and 2000 (n=2,097) and the donor organs of 1998 and 1999 (n=1,520). Overall and subgroup waiting list mortality were estimated for allocation policies differing by ABO blood group, border, and clinical profile rules. RESULTS The model estimated that international organ exchange reduces waiting list mortality in the different countries by 1.9% to 12.4%. An allocation policy incorporating the initial clinical profile of the transplant candidates further reduced waiting list mortality by 1.7%. Changing ABO rules toward identical matching yielded a slightly more equitable survival for the different groups, without an overall effect on mortality. The best possible allocation policy is the policy where organs are allocated to patients that are at highest risk of dying, and withholding organs from patients that would eventually delist because of improvement. CONCLUSIONS Patients benefit from international organ exchange and by a heart allocation scheme based on clinical profiles. Timely delisting of patients who are-temporarily-too well for transplantation is the best waiting list policy.
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Affiliation(s)
- Wilbert B van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
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Smits JMA, Deng MC, Hummel M, De Meester J, Schoendube F, Scheld HH, Persijn GG, Laufer G, Van Houwelingen HC. A prognostic model for predicting waiting-list mortality for a total national cohort of adult heart-transplant candidates. Transplantation 2003; 76:1185-9. [PMID: 14578751 DOI: 10.1097/01.tp.0000091171.82384.33] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current trends in medical management of advanced heart failure and transplant medicine and the enactment of a national transplant law forced a change toward allocation driven by disease severity. OBJECTIVE The aim of this study was to create a model for predicting waiting-list survival on the basis of simple clinical parameters. METHODS The clinical profiles of all patients registered for heart transplantation in Germany in 1997 (n=889) were used as a derivation set, and the total German 1998 cohort (n=897) was used as a validation set. The model was validated by the c statistic and by comparison of risk stratified mortality rates. The validated model was fine tuned by the appropriate calibration procedures. The data were first classified into physiologic subscores: an urgency score, a left ventricular heart failure score, a right ventricular heart failure score, and a systemic heart failure score. A stepwise modeling procedure was undertaken using these subscores as factors as well as the recipient's age, ABO blood group, and body surface area. RESULTS The urgency and the left ventricular subscore were found to be significantly associated with waiting-list mortality. A summary index termed German Transplant Society (GTS) score was then calculated on the basis of seven parameters contained in these two subscores. The GTS score was able to predict waiting-list mortality risks for the 1998 cohort: 1-year mortality before transplantation was 71%, 34%, 11% for the high, medium, and low risk groups, respectively. CONCLUSION The use of this continuous disease severity index may improve the selection of cardiac transplant candidates.
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Sokal EM, Cleghorn G, Goulet O, Da Silveira TR, McDiarmid S, Whitington P. Liver and intestinal transplantation in children: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2002; 35 Suppl 2:S159-72. [PMID: 12192185 DOI: 10.1097/00005176-200208002-00014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Etienne M Sokal
- European Society for Paediatric Gastroenterology, Hepatology, and Nutrition
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Russell BJ. Fair Distribution and Patients Who Receive More than One Organ Transplant. THE JOURNAL OF CLINICAL ETHICS 2002. [DOI: 10.1086/jce200213104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
Due to the shortage of oocyte donors, the waiting lists are lengthening. This raises the ethical question of how the available oocytes should be distributed among candidate recipients. The paper clarifies the ethical structure of the allocation process to find a set of rules that generates decisions that are acceptable for all people involved. The selection includes two steps: admission to the waiting list and ranking of those on the list. The following criteria can be used to decide about the admission of candidates: success rate, health risks, age, parental competence, nationality, primary versus secondary infertility, and capacity to pay. Four criteria may function to rank recipients who should have first priority for receiving oocytes: waiting time, medical urgency, phenotypic matching, and synchronization. The introduction of a point system is defended because it allows balancing of the different ethical principles involved and because it installs an objective system of operating rules which avoid favoritism and personal biases.
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Affiliation(s)
- G Pennings
- Department of Philosophy, Pleinlaan 2, Lok, 5 C 442, Free University Brussels, B-1050 Brussels, Belgium.
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Briggs D. Renal replacement therapy. Scott Med J 2000; 44:172-4. [PMID: 10703090 DOI: 10.1177/003693309904400606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- D Briggs
- Renal Unit, Western Infirmary, Glasgow
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Strong RW. Whither living donor liver transplantation? LIVER TRANSPLANTATION AND SURGERY : OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES AND THE INTERNATIONAL LIVER TRANSPLANTATION SOCIETY 1999; 5:536-8. [PMID: 10545545 DOI: 10.1002/lt.500050613] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Affiliation(s)
- J H Dark
- Cardiothoracic Unit, Freeman Hospital, Newcastle upon Tyne, UK
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