RATIONING ORGANS USING PSYCHOSOCIAL AND LIFE-STYLE CRITERIA

The role of patient psychosocial and lifestyle characteristics in deci sions about the allocation of scarce health care resources has not bee n examined. In this national survey using the Criteria for Selection o f Transplant Recipient (CSTR) Scale, organ transplant coordinators (N = 559) identified the psychosocial and lifestyle criteria they believe should be considered in patient selection/rejection for organ transpl ant. Using factor analysis to reduce the data, six factors were identi fied: current lifestyle/psychiatric problems, family/socioeconomic iss ues, habits, controlled lifestyle/psychiatric issues, cost, and stigma tized conditions. Patients who were in prison for a serious crime, use d cocaine, had AIDS, or were HIV positive (criteria making up the Stig ma factor), were more likely to be labeled for exclusion from transpla nt than those with other psychosocial/lifestyle characteristics. When transplant coordinators perceived that patients' psychosocial and life style problems were under control or corrected, they were more likely to consider them for a transplant. For all but the cost factor, criter ia were most stringent for heart transplants. Although over 90% of the coordinators assessed patients and participated in patient selection for transplant, master's prepared nurses were more likely than nurses with other educational preparation to be involved in organ recipient s election. These findings can serve as a prototype for how decisions ar e made for allocating other scarce health care resources. (C) 1998 Joh n Wiley & Sons, Inc.