Open Access Research article

Patient preferences for the allocation of deceased donor kidneys for transplantation: a mixed methods study

Allison Tong12*, Stephen Jan3, Germaine Wong124, Jonathan C Craig12, Michelle Irving12, Steve Chadban5, Alan Cass3, Niamh Marren2 and Kirsten Howard1

Author Affiliations

1 Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia

2 Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia

3 Renal and Metabolic Division, The George Institute for Global Health, Sydney, NSW 2050, Australia

4 Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW 2145, Australia

5 Central Clinical School, Bosch Institute, The University of Sydney, Sydney, NSW 2006, Australia

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BMC Nephrology 2012, 13:18  doi:10.1186/1471-2369-13-18

Published: 18 April 2012



Deceased donor kidneys are a scarce health resource, yet patient preferences for organ allocation are largely unknown. The aim of this study was to determine patient preferences for how kidneys should be allocated for transplantation.


Patients on dialysis and kidney transplant recipients were purposively selected from two centres in Australia to participate in nominal/focus groups in March 2011. Participants identified and ranked criteria they considered important for deceased donor kidney allocation. Transcripts were thematically analysed to identify reasons for their rankings.


From six groups involving 37 participants, 23 criteria emerged. Most agreed that matching, wait-list time, medical urgency, likelihood of surviving surgery, age, comorbidities, duration of illness, quality of life, number of organs needed and impact on the recipient's life circumstances were important considerations. Underpinning their rankings were four main themes: enhancing life, medical priority, recipient valuation, and deservingness. These were predominantly expressed as achieving equity for all patients, or priority for specific sub-groups of potential recipients regarded as more "deserving".


Patients believed any wait-listed individual who would gain life expectancy and quality of life compared with dialysis should have access to transplantation. Equity of access to transplantation for all patients and justice for those who would look after their transplant were considered important. A utilitarian rationale based on maximizing health gains from the allocation of a scarce resource to avoid "wastage," were rarely expressed. Organ allocation organisations need to seek input from patients who can articulate preferences for allocation and advocate for equity and justice in organ allocation.