PUBLIC PERCEPTIONS OF THE IMPORTANCE OF PROGNOSIS IN ALLOCATING TRANSPLANTABLE LIVERS TO CHILDREN

Background. The system to allocate scarce transplantable livers has be en criticized for not giving enough weight to the prognoses of the pat ients receiving the transplants, but little research has been done loo king at how the public weights the relative importances of efficacy an d equity in distributing the organs. Methods. This study was an experi mental survey of prospective jurors asked to distribute transplantable livers among transplant candidates grouped according to their prognos es. The relative prognoses of the transplant candidates were varied ac ross survey versions. Results. As the prognostic difference between tr ansplant groups increased, the subjects became less likely to distribu te the organs equally between them (p < 0.005). However, the subjects' willingness to base allocation on prognosis was moderated by a number of factors, including their understanding of how to use prognostic in formation and their attitudes toward using prognostic information for individuals versus groups. Thus, even when the relative prognoses of t ransplant groups differed by 60%, less than a fourth of the subjects w ere willing to give all the organs to the better-prognosis group. Conc lusion. Many subjects feel that prognosis is an important consideratio n in allocating scarce livers. However, few are willing to base alloca tion purely on maximizing survival. Policies that base allocations pur ely on outcomes will violate the values of a significant portion of th e public.