Attitudes, knowledge, and preferences of the Israeli public regarding the allocation of donor organs for transplantation

Abstract

Background: There is a stark disparity between the number of patients awaiting deceased-donor organ transplants and the rate at which organs become available. Though organs for transplantation are assumed to be a community resource, and the organ supply depends on public willingness to donate, current allocation schemes do not explicitly incorporate public priorities and preferences. This paper seeks to provide insights regarding the Israeli public's preferences regarding criteria for organ (specifically, kidney) allocation, and to determine whether these preferences are in line with current allocation policies.

Methods: A market research company administered a telephone survey to 604 adult participants representing the Jewish-Israeli public (age range: 18-95; 50% male). The questionnaire comprised 39 questions addressing participants' knowledge, attitudes, and preferences regarding organ donation and criteria for organ allocation, including willingness to donate.

Results: The criteria that respondents marked as most important in prioritizing waitlist candidates were maximum medical benefit (51.3% of respondents) and waiting time (21%). Donor status (i.e., whether the candidate is registered as an organ donor) was ranked by 43% as the least significant criterion. Most participants expressed willingness to donate the organs of a deceased relative; notably, they indicated that they would be significantly more willing to donate if organ allocation policies took their preferences regarding allocation criteria into account. Unlike individuals in other countries (e.g., the UK, the US, and Australia) who responded to similar surveys, Israeli survey respondents did not assign high importance to the candidate's age (24% ranked it as the least important factor). Interestingly, in some cases, participants' declared preferences regarding the importance of various allocation criteria diverged from their actual choices in hypothetical organ allocation scenarios.

Conclusions: The findings of this survey indicate that Israel's citizens are willing to take part in decisions about organ allocation. Respondents did not seem to have a strict definition or concept of what they deem to be just; yet, in general, their preferences are compatible with current policy. Importantly, participants noted that they would be more willing to donate organs if their preferences were integrated into the allocation policy. Accordingly, we propose that allocation systems must strive to respect community values and perceptions while maintaining continued clinical effectiveness.

Keywords: Allocation policy; Equity; Kidney transplantation; Medical efficiency; Organ donations; Public preferences.

Fig. 1

Organ shortage in the United States [1], ** Data include deceased and living donors

Fig. 2

Familial consent in Israel [8]

Fig. 3

Most important criteria in prioritizing waitlist candidates, according to the survey population

Fig. 4

Least important criteria in prioritizing waitlist candidates, according to the survey population

Fig. 5

Distribution of religious affiliation in the survey population compared to the national average

Fig. 6

Comparison of donor status in the official donor registry versus in the survey