Healthcare professional and community preferences in deceased donor kidney allocation: a best‐worst scaling survey

Abstract

Deceased donor kidneys are a scarce community resource; therefore, the principles underpinning organ allocation should reflect societal values. This study aimed to elicit community and healthcare professional preferences for principles guiding the alloca-tion of kidneys from deceased donors and compare how these differed across the populations. A best-worst scaling survey including 29 principles in a balanced incom-plete block design was conducted among a representative sample of the general com-munity (n= 1237) and healthcare professionals working in transplantation (n= 206). Sequential best-worst multinomial logistic regression was used to derive scaled pref-erence scores (PS) (range 0–100). Thematic analysis of free text responses was per-formed. Five of the six most valued principles among members of the community related to equity, including priority for the longest waiting (PS 100), difficult to trans-plant (PS 94.5) and sickest (PS 93.9), and equitable access for men and women (PS 94.0), whereas the top four principles for healthcare professional focused on maximiz-ing utility (PS 89.9–100). Latent class analysis identified unmeasured class member-ship among community members. There are discordant views between community members and healthcare professionals. These should be considered in the design, evaluation, and implementation of deceased donor kidney allocation protocols.