International Choice Modelling Conference, International Choice Modelling Conference 2015

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Preferences for policy options for deceased organ donation for transplantation
Kirsten Howard, Stephen Jan, John M Rose, Germaine Wong, Jonathan C Craig, Michelle Irving, Allison Tong, Steven Chadban, Richard Allen, Alan Cass

Last modified: 11 May 2015

Abstract


Background and context

Whilst solid organ transplantation is the treatment of choice for those with organ failure, the demand for organs for transplant far exceeds supply.  Although there is widespread public support for organ donation this is not reflected in actual donor intent registrations; for example, only around 23% of Australians have registered a donation intention, despite over 75% of the population having positive views towards donation(1).  There is considerable evidence on the individual respondent factors associated with being an organ donor. People with higher education, higher socio-economic status and younger age tend to be more willing to donate.  Knowledge about organ donation policy (specifically the consent system) has also been found to be associated with a higher likelihood of donation. However, there is considerably less research on the influence of, and preferences for, other ‘systemic' factors, for example those factors that could act as policy levers to encourage donation. Qualitative research suggests personal, cultural and systemic factors influence individuals' decisions on being an organ donor however there is a paucity of quantitative data on the relative importance of various systemic factors on community's preferences for type of organ donation system or policy, or on the influence of personal characteristics on the importance of these policy characteristics.  Discrete choice experiments (DCEs) are a valid, reliable and widely applied survey methodology for eliciting preferences for health care services; however they are less commonly used to assess preferences for health policy options(2,3).

Previous qualitative work suggests considerable variability in the acceptability of various policy options to different people (4,5).  Therefore, despite policy change necessitating a one size fits all approach to implementation, we sought to examine both the underlying societal preferences for alternative organ donation policies, as well as the characteristics of people who viewed specific policy mechanisms positively and negatively, to understand the possible effect of policy levers on donor registration. For example if people who viewed a particular policy change negatively were also those who were opposed to donation per se, then changes are not likely to negatively impact on current donation rates.  Similarly, if the only respondents who viewed a specific policy change positively were those who were already registered as donors, then that policy change is unlikely to impact on donor registration rates. This study therefore sought to quantify societal preferences for organ donation policies and to identify whether particular groups of respondents viewed specific policy mechanisms as more, or less, preferred than the current policy.

Methods

A discrete choice study was conducted using an online panel of Australian community respondents aged 18 and over.  Respondents were presented with scenarios comparing a ‘new' policy to the current organ donation policy.  Trade-offs between 8 policy aspects, originally identified through a focus group study, were quantified using both mixed logit and latent class models: how donation intention is registered (the type of consent system); whether a donor's family has the final say about donation; how easy it is to register; how frequently donation intent is re-confirmed; the value of any payment to donor's family; the value of any reimbursement of funeral expenses; whether a donor's family receives priority for organs in the future; and whether a donor's family receives any formal recognition of the donation.  All analyses were conducted in NLOGIT 5.0.

Results

There were 2005 respondents with a mean age of 44.6 years (range18-87); 51.5% were female.  The mixed logit model indicated a strong underlying preference for a new compared to current policy.  On average, the mixed logit indicated that the type of donation consent system and the family priority for transplants in the future did not influence preferences for policy. Overall, respondents favoured a policy where: the donor's family still had some involvement in the final donation decision, the registration process was easy, for example by sending all adults a registration form and reply paid envelope, reconfirmation of donation intent was less frequent, there was a direct payment or funeral expense reimbursement (of even a small amount), and there was some non-monetary mechanism such as a formal recognition of donation, for example a letter to the donor's family, or the donor's name being added to a memorial.  However, the mixed logit results also indicated significant heterogeneity across respondents, even for attributes that appeared to not significantly influence overall preferences such as the type of consent system.  The latent class analysis suggested those respondents who had a very strong preference for the status quo, and viewed almost all potential alternative policy options as significantly less preferred to the current policy tended to be older, less likely to be registered donors, more likely to hold negative organ donation views, less likely to be in full time employment, and less likely to speak English at home.  In other respondent classes, a new policy, compared to current policy was preferred, although the strength of preference for various policy mechanisms varied across respondents classes: Some respondent classes favoured consent system changes as well as both monetary and non-monetary mechanisms; some favoured only monetary or non-monetary mechanisms, while others favoured only consent system changes.  

Conclusions

Our results suggest that the Australian community are open to alternative organ donation policies including changes to donation registration systems, levels of family involvement and financial and non-financial mechanisms. Future policy discussions and options should not be limited by preconceived notions of what is acceptable to the community.

References

1.    Mathew T, Faull R, Snelling P. The shortage of kidneys for transplantation in Australia. Medical Journal of Australia 2005;182: 204-205.

2.    Shanahan M, Gerard K, Ritter A. Preferences for policy options for cannabis in an Australian general population: A discrete choice experiment. International Journal of Drug Policy 2014;25: 682-690.

3.    Pechey R, Burge P, Mentzakis E, Suhrke M, Marteau TM. Public acceptability of population-level interventions to reduce alcohol consumption: A discrete choice experiment. Social Science & Medicine 2014;113: 104-109.

4.    Irving MJ, Tong A, Jan S et al. Community attitudes to deceased organ donation: a focus group study. Transplantation 2012;93: 1064-1069.

5.    Irving MJ, Tong A, Wong G et al. Community preferences for the allocation of organs for transplantation. Nephrol Dial Transplant 2013;28: 2187-2193.

 

 


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