Assessing priorities for allocation of donor liver grafts: survey of public and clinicians
Assessing priorities for allocation of donor liver grafts: survey of public and clinicians
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DOI：
10.1136/bmj.317.7152.172
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发表时间：
1998-07-18
影响因子：
105.7
通讯作者：
Speed, M
中科院分区：
文献类型：
--
作者：
Neuberger, J;Adams, D;Speed, M
目的：比较公众、家庭医生和胃肠病学家在分配供肝给肝移植潜在受体时的优先顺序。设计：对1000名公众和200名家庭医生进行代表性配额抽样，并对100名胃肠病学家进行邮寄问卷调查。受访者获得了八个假设的病史（基于真实的患者），并被要求选择四个捐赠肝脏的接受者。选择病例以确定有争议的领域，如年龄极端，滥用酒精和静脉注射药物。受访者还被要求选择最不值得的情况下，七个可能的因素（在等待名单上的时间，结果，年龄，对社会的价值，返回工作，宝贵的使用非法药物，并参与酒精的肝损伤）应被用来选择已经列出的移植患者。结果：三组受试者在接受者的选择上存在显著差异。尽管酗酒和反社会行为的重要性一直很低，但公众认为，按重要性降序排列，年龄、结果、在等待名单上的援助时间是选择受援者的最重要因素;家庭医生评估移植后的结果、年龄和可能的工作状态，胃肠病学家评估移植后的结果、工作状态，结论：公众的观点与临床医生的观点不一致。需要进行进一步的辩论，以确保公平和适当地分配稀缺资源。
Objectives: To compare the priorities of the general public, family doctors, and gastroenterologists in allocating donor livers to potential recipients of liver allograft.Design: Representative quota sampling of 1000 members of the general public and 200 family doctors, and a postal questionnaire of 100 gastroenterologists.Subjects: Respondents were given eight hypothetical case histories (based on real patients) and asked to select recipients for four donor livers. Cases were selected to identify controversial areas such as extremes of age, misuse of alcohol, and intravenous drugs. Respondents were also asked to select the least deserving case and which of seven possible factors (time on waiting list, outcome, age, value to society, return to work, precious use of illicit drugs, and involvement of alcohol in the liver damage) should be used to select patients already listed for transplantation. Focus groups were also held to explore farther the reasons for the choices given.Results: There were considerable differences between the three groups in the choice of the recipients. although alcohol use and antisocial behaviour always rated low For selection of recipients the general public thought that, in decreasing order of importance, age, outcome, aid time on the waiting list were the most important factors in selecting recipients; family doctors rated outcome, age, and likely work status after transplantation and the gastroenterologists outcome, work status, and non-involvement of alcohol in the cause of the liver disease as the most important factors.Conclusions: The views of the public are at variance with those of clinicians. Further debate is required to ensure an equitable and appropriate distribution of a scarce resource.