THE EFFICACY AND EQUITY OF RETRANSPLANTATION - AN EXPERIMENTAL SURVEYOF PUBLIC-ATTITUDES

Purpose: To measure the relative importance people place on prognosis and retransplantation status in allocating scarce transplantable liver s. Methods: 138 subjects were asked to distribute scarce livers amongs t transplant candidates with either a 70% chance or a 30% chance of su rviving if transplanted, In one group of subjects, the prognostic diff erence was based on the presence or absence of a 'blood marker.' In th e other group, the prognostic difference was based on whether candidat es had been previously transplanted or not, with retransplant candidat es having a 30% chance of surviving if transplanted. Results: Subjects answering the retransplantation survey gave a higher percentage of or gans to the better prognostic group than subjects answering the blood marker survey, with a mean of 71.6% versus 65.0%, although this differ ence fell just short of statistical significance (P = 0.0581). Retrans plantation survey respondents were significantly less likely to want t o ignore prognostic information than were blood marker respondents (P = 0.026). Subjects in both survey groups were equally unwilling to aba ndon the poor prognostic group, with only 18% in each group choosing t o give all the available organs to the better prognostic group. Conclu sions: Respondents reacted more strongly to prognostic differences whe n they were due to retransplant status than to the results of a blood test, However, most people were not solely interested in the aggregate medical benefit brought by different allocation systems, but were als o interested in the amount of benefit brought to the worst off.