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Presenter: Stephen, Jan, Sydney, Australia
Authors: Kirsten Howard, Stephen Jan, John M. Rose, Michelle Irving, Germaine Wong, Allison Tong, Jonathan C. Craig, Steven Chadban, Richard D. Allen, Alan Cass
Deciding to donate a family member’s organs: what factors are most important to the community? Results of a best-worst scaling study
Kirsten Howard1, Stephen Jan2, John M. Rose3, Michelle Irving1,4, Germaine Wong1,4, Allison Tong1,4, Jonathan C. Craig1,4, Steven Chadban5,6, Richard D. Allen6, Alan Cass2,7
1School of Public Health, University of Sydney, Sydney, Australia, 2The George Institute for International Health, Sydney, Australia, 3Institute for Transport and Logistics Studies, University of Sydney, Sydney, Australia, 4Centre for Kidney Research, The Children's Hospital Westmead, Westmead, Australia, 5Central Clinical School, Bosch Institute, University of Sydney, Sydney, Australia, 6Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia, 7Menzies School of Health Research, Casuarina, Australia
Background: Despite broad public support for organ donation, there is a chronic shortage of deceased donor organs. The final decision on organ donation is made by donor’s families. We aimed to identify the key factors influencing decisions to donate a family member’s organs
Methods: A best-worst-scaling method was used where policies/services are described by factors presented with varying levels. Community respondents were recruited from an existing internet panel; quota sampling ensured they were broadly representative of the adult Australian age distribution. Participants answered 30 online scenarios presenting eight factors (Table1), and chose, in each, the factor that made them most likely, and least likely, to agree to donate their family member’s organs. Using MNL regression we calculated: the importance of each factor, and the contribution each factor made to overall utility of a policy
Results: There were 2002 respondents with a mean age of 44.9 (range18-84); 51.9% were female. The importance ranking of attributes is shown below (Table1), with knowing a family member’s preference ranked highest. The largest gains in overall utility of a policy could be achieved from: knowing a family member’s preferences, by telling the family how death is defined, by giving family priority for organs in the future, and provision of direct payments. There were some differences in the valuation of attributes with respondent age, with respondents <50 yrs valuing financial mechanisms more highly than older people
Conclusions: Knowing a family member’s wishes about donation was the most important factor. Conversely, less important attributes such as funeral expense reimbursement and direct payments contributed positively to overall policy utility, suggesting the Australian public is open to donation policies that include financial mechanisms
Factors presented |
Factor importance score |
Rank importance of factor |
Overall impact of factor levels on utility of policy |
Rank of utility impact |
Whether you know family members preferences |
1.057 |
1 |
3.800 |
1 |
Whether family receive a direct payment |
0.412 |
2 |
0.885 |
4 |
Who discusses organ donation with family |
0.333 |
3 |
0.683 |
7 |
How death is defined |
0.310 |
4 |
1.610 |
2 |
Whether family receive priority for organs in the future |
0.157 |
5 |
0.914 |
3 |
Whether family receive reimbursement of funeral expenses |
0.132 |
6 |
0.832 |
5 |
Whether you are told anything about the recipient |
0.116 |
7 |
0.526 |
8 |
Whether there is any formal acknowledgement of donation (base factor) |
0 |
8 |
0.816 |
6 |
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