Selection criteria for recipients of scarce donor livers: a public opinion survey in Hong Kong

HM Chan, GMY Cheung, AKW Yip
Department of Public and Social Administration, Faculty of Humanities and Social Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong

OBJECTIVE. To explore the public preference in determining the selection criteria for recipients of scarce donor livers.

DESIGN. Structured interview survey.

SETTING. Hong Kong community.

PARTICIPANTS. Participants from Hong Kong households, randomly drawn from 18 districts in Hong Kong by the Census and Statistics Department.

MAIN OUTCOME MEASURES. Age of patients, causes of liver failure, capacity for survival and benefit, time spent on the waiting list, and transplantation status.

RESULTS. A total of 281 participants were recruited with the response rate of 26.2%. In all sections of the questionnaire, there was a strong preference for the young over the old, non-drinkers over drinkers, those more likely to survive, those who had waited longest on the list, and primary candidates over re-transplant candidates. Approximately 91% of participants agreed or strongly agreed that priority should be given to patients most likely to survive and benefit from a liver transplant, and 39% of participants also ranked ‘survival and benefit’ as the most important criterion in determining allocation of donor livers. Nonetheless when participants were asked to allocate a finite number (100) of donor livers to two groups of individuals with different characteristics in a set of eight hypothetical scenarios, they preferred giving priority to patients who had waited longer on the waiting list.

CONCLUSION. Although comparatively the general public surveyed had dominant preferences to maximise benefit and survival, they were unlikely to rely on one criterion for allocation. Overall cost-effectiveness of the intervention was not the sole deciding factor.

Hong Kong Med J 2006;12:40-6

Key words: Liver transplantation; Patient selection; Public opinion; Social justice; Tissue and organ procurement