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Open Access Highly Accessed Research article

Who should be prioritized for renal transplantation?: Analysis of key stakeholder preferences using discrete choice experiments

Michael D Clark1*, Dennis Leech2, Anil Gumber3, Domenico Moro4, Ala Szczepura5, Nick West6 and Robert Higgins6

Author Affiliations

1 Warwick Medical School, University of Warwick, CV4 7AL, Coventry, UK

2 Department of Economics, University of Warwick, Coventry, UK

3 Centre for Health and Social Care Research, Faculty of Health and Wellbeing, Sheffield Hallam University Collegiate Campus, 32 Colliegiate Crescent, Room 205, S10 2BP, Sheffield, UK

4 Third Sector Research Centre, University of Birmingham, Park House, 40, Egbaston Road, B15 2RT, Birmingham, UK

5 Warwick Medical School, University of Warwick, Coventry, UK

6 Nephrology Department, University Hospital, CV2 2DX, Walsgrave, Coventry, UK

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BMC Nephrology 2012, 13:152  doi:10.1186/1471-2369-13-152

Published: 22 November 2012

Abstract

Background

Policies for allocating deceased donor kidneys have recently shifted from allocation based on Human Leucocyte Antigen (HLA) tissue matching in the UK and USA. Newer allocation algorithms incorporate waiting time as a primary factor, and in the UK, young adults are also favoured. However, there is little contemporary UK research on the views of stakeholders in the transplant process to inform future allocation policy. This research project aimed to address this issue.

Methods

Discrete Choice Experiment (DCE) questionnaires were used to establish priorities for kidney transplantation among different stakeholder groups in the UK. Questionnaires were targeted at patients, carers, donors / relatives of deceased donors, and healthcare professionals. Attributes considered included: waiting time; donor-recipient HLA match; whether a recipient had dependents; diseases affecting life expectancy; and diseases affecting quality of life.

Results

Responses were obtained from 908 patients (including 98 ethnic minorities); 41 carers; 48 donors / relatives of deceased donors; and 113 healthcare professionals. The patient group demonstrated statistically different preferences for every attribute (i.e. significantly different from zero) so implying that changes in given attributes affected preferences, except when prioritizing those with no rather than moderate diseases affecting quality of life. The attributes valued highly related to waiting time, tissue match, prioritizing those with dependents, and prioritizing those with moderate rather than severe diseases affecting life expectancy. Some preferences differed between healthcare professionals and patients, and ethnic minority and non-ethnic minority patients. Only non-ethnic minority patients and healthcare professionals clearly prioritized those with better tissue matches.

Conclusions

Our econometric results are broadly supportive of the 2006 shift in UK transplant policy which emphasized prioritizing the young and long waiters. However, our findings suggest the need for a further review in the light of observed differences in preferences amongst ethnic minorities, and also because those with dependents may be a further priority.

Keywords:
Renal transplant; Allocation; Choice experiment; Stakeholder