[The Trade-Off between Chance of Success and Urgency in Organ Allocation: A Discrete Choice Experiment to Elicit Public Preferences]

Allokation knapper medizinischer Ressourcen auf COVID-19-PatientInnen. Ergebnisse einer Vignettenstudie

Ziel der Studie

In der vorliegenden Studie werden Knappheitsentscheidungen von medizinischen Laien bei der Behandlung von COVID-19(„Coronavirus Disease 2019“)-Patienten untersucht.

Methodik

In den multivariaten clusterkorrigierten Regressionen werden die Antworten auf 1802 Fallsituationen einer Vignettenstudie ausgewertet, die von 181 medizinischen Laien eingeschätzt wurden.

Ergebnisse

Jüngere Patienten, Männer, Erkrankte mit hohen Genesungschancen, eigenen Kindern und einem Beruf in einem Krankenhaus werden von den medizinischen Laien bevorzugt eingestuft.

Schlussfolgerung

Medizinische Laien wenden bewusst oder unbewusst soziale Kriterien der Entscheidungsfindung bei Knappheit der medizinischen Ressourcen an, die aus professioneller medizinischer und ethischer Sicht unzulässig sind. Zur Einschätzung der Akzeptanz in der allgemeinen Bevölkerung sollte dieser Umstand berücksichtigt werden.

Organ Transplantation in the Face of Donor Shortage - Ethical Implications with a Focus on Liver Allocation

BACKGROUND

Transplantation medicine is associated with several ethical issues related to the lack of organs. Major questions concern the regulations for giving permission for organ removal, informing the public about organ donation, setting of organ allocation priorities, waiting list access, and strategies to counteract scarcity.

METHODS

This contribution is based on analyses of legal regulations, guidelines of self-regulatory bodies, administrative data, and literature from medical, normative, and empiric disciplines. It addresses the above-mentioned issues descriptively with a focus on Germany and liver transplantation.

RESULTS

The basic principle of beneficence justifies a shift from voluntariness towards an obligation to document one's decision regarding organ donation. Organ allocation is obviously tangent to fundamental values and concepts of justice. At that, there is no consistent agreement on whether to prioritize the sickest patient or to maximize the overall health benefit. Restrictions relating to waiting list access are the subject of controversies. The reasons for denial of access are largely related to high demands on the prospect of success. Strategies to counteract organ scarcity partly conflict with the respect for autonomy, non-maleficence, beneficence, or justice.

CONCLUSION

We propose to focus on recent most promising strategies to counteract scarcity in the short-term: demanding a documented decision on organ donation and an orientation towards the Spanish model of organization. Concepts for waiting list access should constantly be reviewed considering all medical evidence and must not be based on moralism. Moreover, we suggest to consider public preferences for organ allocation and strengthen the confidence in transplantation medicine.