Objectives This study aims to investigate factors with a significant influence on deceased organ donation rates in Organisation for Economic Co-operation and Development (OECD) countries and determine their relative importance. It seeks to provide the necessary data to facilitate the development of more efficient strategies for improving deceased organ donation rates.Design Retrospective study.Setting Publicly available secondary annual data.Participants The study includes 36 OECD countries as panel members for data analysis.Outcome measures Multivariable panel data regression analysis was employed, encompassing data from 2010 to 2018 for all investigated variables in the included countries.Results The following variables had a significant influence on deceased organ donation rates: ‘opt-in’ system (β=−4.734, p<0.001, ref: ‘opt-out’ system), only donation after brain death (DBD) donors allowed (β=−4.049, p=0.002, ref: both DBD and donation after circulatory death (DCD) donors allowed), number of hospital beds per million population (pmp) (β=0.002, p<0.001), total healthcare employment pmp (β=−0.00012, p=0.012), World Giving Index (β=0.124, p=0.008), total tax revenue as a percentage of gross domestic product (β=0.312, p=0.009) and percentage of population aged ≥65 years (β=0.801, p<0.001) as well as high education population in percentage (β=0.118, p=0.017).Conclusions Compared with the promotion of socioeconomic factors with a positive significant impact on deceased organ donation rates, the following policies have been shown to significantly increase rates of deceased organ donation, which could be further actively promoted: the adoption of an ‘opt-out’ system with presumed consent for deceased organ donation and the legal authorisation of both DBD and DCD for transplantation.

Purpose: Organ transplantation systems benefit from guidelines that are harmonious with the preferences of the people involved. Discrete choice experiments are useful tools for eliciting preferences. Patients and Methods: This study evaluated the preferences of patients and their relatives (n=285) to identify their priorities in organ allocation using a discrete choice experiment. In eight hypothetical allocation decisions, the participants were asked to select the candidate they considered the most suitable The candidates differed in years of life gained after transplantation, quality of life after transplantation, waiting time until transplantation, age, compliance and social support. Results: The most important aspects for setting priority in organ allocation were lack of compliance (beta= -2.5, p<0.001) and good quality of life after transplantation (beta = +1.4, p<0.001). The lack of social support (ss = -0.8, p<0.05) and the more years of life gained after transplantation (beta = +0.5, p<0.001) had less but still a significant amount of influence on this decision, while the waiting list was not considered significantly important (beta = 0.1, p>0.05). The comparison of the different relations to transplantation showed that life years gained after transplantation was of high relevance to posttransplant patients (+10 years: beta = +0.709, p<0.001 / +15 years: beta = +0.700, p<0.001) and of no importance to waitlisted patients (+10 years: beta = +0.345, p>0.05 / + 15 years: beta = +0.173, p>0.05) and relatives (+ 10 years: beta = +0.063, p>0.05 / +15 years: beta = +0.304, p>0.05). Conclusion: This study provides useful insights into the unique perspective of patients and their relatives on priority-setting in the allocation of donor organs that should be reflected in improved donor organ allocation rules.

OBJECTIVES:This systematic review aims to derive practical lessons from publications on patient involvement and engagement in the organisation of organ transplantation services.DESIGN:This systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Inclusion criteria for the analysis of publications in English cited in the databases PubMed and Web of Science until 6 December 2022 required that patients participated as advisers in the organisation of organ transplantation services. Quality assessment was performed using the Guidance for Reporting Involvement of Patients and the Public (GRIPP) 2 small form and the Critical Appraisal Skills Programme (CASP) tool for the assessment of the risks of bias.RESULTS:Deployed search strings identified 2263 records resulting in a total of 11 articles. The aims and strategies, deployed methods, observed effects, observed barriers and proposed improvements for the future varied vastly. All reported that well-developed programmes involving and engaging patients at an organisational level provide additional benefits for patients and foster patient-centred care. Lessons learnt include: (1) to empower patients, the information provided to them should be individualised to prioritise their needs; (2) financial as well as organisational resources are important to successfully implement patient involvement and engagement; (3) systematic feedback from patients in organisational structures to health providers is required to improve clinical workflows and (4) the consideration of ethical issues and the relationship between investigators and participating patients should be clarified and reported.CONCLUSIONS:Actionable management recommendations could be derived. The quantitative impact on clinical outcome and economic clinical process improvements remains to be investigated. Study quality can be improved using the GRIPP 2 guidance and the CASP tool.PROSPERO REGISTRATION NUMBER:CRD42022186467.

Purpose:The gap between the supply and demand for deceased donor organs is increasing worldwide, while patients on waiting lists for organ transplantation die. This situation requires ethical donor organ allocation rules. The patients' perspective on donor organ allocation rules offers a highly relevant and unique perspective that may differ from the perspectives of physicians and the general public.Patients and Methods:Semi-structured telephone interviews were conducted with the regional group coordinators of the federal self-help organization for organ transplanted patients and their relatives in Germany in early 2021. Twelve interviews were conducted with patients and relatives of transplantation patients who received transplants for the affected organs including the lungs, heart, kidney, and liver. Transcripts were analyzed using the deductive framework method which was based on an earlier study. All criteria were reported following the COREQ statement.Results:Participants emphasized aspects of "medical urgency" and "effectiveness/benefit" of transplantation and associated trade-offs as well as the recipient's responsibility for organ failure ("own fault"), the appreciation for the gifted graft and the patient's capability of taking care of it ("appreciation/responsibility"). Patients acknowledged that urgent patients should be prioritized and they showed a clear preference toward allocation rules that strive to maximize both the life years and quality of life gained by transplantation.Conclusion:The patients' perspective is unique in that patients agree on certain rules for allocation and share many preferences, but also have a hard time finding clear cutoff points when considering selecting a participant for allocation. Patient representatives should therefore be consulted in the debate on donor organ allocation rules.

Zusammenfassung Die Akzeptanz der Bevölkerung ist eine wesentliche Voraussetzung für die erfolgreiche Umsetzung regulatorischer Entscheidungen in der COVID-19 Pandemie. Um Politikkommunikation zu unterstützen, wurden weltweit Discrete Choice Experimente (DCE) zu Lockdown-Maßnahmen durchgeführt. Handlungsempfehlungen aus DCE zu generieren ist aufwendiger, als aus Standardbefragungen. DCE unterstützen dafür eher die Entwicklung von Maßnahmen, die gleichzeitig evidenzbasiert sind und von der Bevölkerung akzeptiert werden.

INTRODUCTION:Accurate estimations of potential organ donors (POTDs) are required to improve transplant systems. This systematic review analyses current studies on national estimations of potential donors for transplantation as well as the practical and policy implications of detected differences.METHOD:A systematic review of literature published between 01.01.2010 and 01.04.2020 in PubMed was conducted. Data was extracted into a self-developed matrix, and further data retrieved on national population sizes, waiting lists and transplant activities.RESULTS:Six studies were included. Investigated populations, underlying data collections and eligibility criteria for POTDs varied widely. Estimated POTDs per million population (p.m.p.) ranged from 25.8 to 333.6, conversion rates from 3.2% to 47.5% leading to 41.2 to 86.4 transplanted organs p.m.p.. Patients on the waiting lists varied from 66.7 to 338.9 p.m.p., defining gaps between organ supply and demand in countries. Not all studies adhered to the definitions and processes of the critical pathway for deceased donation which is the latest international consensus statement on deceased organ donation.CONCLUSION:Differences in estimated POTDs and differences in supply and demand of donor organs between countries cannot be satisfactorily explained yet due to an obvious lack of evidence, consistent methodology, international consensus and robust underlying datasets. Future studies should be based on robust underlying data sets and aim for potential donor estimations that allow national comparisons due to the adherence to the international consensus on definitions, processes and methodology.

Objectives: To decrease the rapid growth of SARS-CoV-2 in Germany, a stepped lockdown was conducted. Acceptance and compliance regarding entering and exiting lockdown measures are key for their success. The aim of the present study was to analyse the population's preferences for exiting lockdown measures.Methods: To evaluate population’s preferences and identify trade-offs between different exit strategies, a discrete choice experiment was conducted on 28–29 April (n = 1,020). Overall, six attributes and 16 choice sets (fractional-factorial design) without an opt-out were chosen. Conditional logit and latent class models were conducted.Results: Most attributes proved to be significant. Two attributes dominated all others: Avoiding a mandatory tracing app, and providing sufficient intensive care capacities. Preventing a high long-term unemployment rate and avoiding the isolation of persons aged 70+, were relevant, though utilities were comparatively lower. We identified subgroups (elderly persons and persons with school children) with different utilities, which indicates specific attributes affecting them dissimilarly.Conclusions: The population prefers cautious re-opening strategies and is at least sceptical about the adoption of severe protection measures. Government should balance interests between subgroups.

This study aimed to assess public preferences for the allocation of donor organs in Germany with the focus on ethical principles of distributive justice. We performed a discrete choice experiment (DCE) using a self-completed online questionnaire. Based on a systematic review and focus group discussions, six attributes, each with two-four levels, were selected (corresponding principle of distributive justice in brackets), including (1) life years gained after transplantation (principle of distributive justice: effectiveness/benefit - utilitarianism), (2) quality of life after transplantation (effectiveness/benefit - utilitarianism), (3) chance for a further donor organ offer (principle of distributive justice: medical urgency - favouring the worst-off), (4) age (medical and social risk factors: sociodemographic status), (5) registered donor (principle of distributive justice: value for society), and (6) individual role in causing organ failure (principle of distributive justice: own fault). Each respondent was presented with eight choice sets and asked to choose between two hypothetical patients without an opt-out. Data were analysed using conditional logit, mixed logit and latent class models. The final sample comprised 1028 respondents. Choice decisions were significantly influenced by all attributes except chance for a further donor organ offer. The attributes of good quality of life after transplantation, younger age, and no individual role in causing organ failure had the greatest impact on choice decisions. Life years gained after transplantation and being a registered donor were less important for the public. The latent class model identified four classes with preference heterogeneities. Respondents preferred to allocate deceased donor organs by criteria related to effectiveness/benefit, whereas medical urgency was of minor importance. Therefore, a public propensity for a rational, utilitarian, ethical model of allocation could be identified. Public preferences can help to inform policy to warrant socially responsible allocation systems and thus improve organ donation rates.

INTRODUCTION:Organ transplantation is the last resort for many patients. The ubiquitous shortage of suitable donor organs raises the question of best-justifiable allocation worldwide. This study investigates how physicians would allocate donor organs.METHODS:Focus group discussions with a total of 12 transplant surgeons and 2 other transplant-related physicians were held at the annual conference of the German Transplantation Society (Oct 2019). Three groups discussed aspects of 'egalitarianism', 'effectiveness/benefit', 'medical urgency', 'own fault', 'medical background' and 'socio-demographic status'.RESULTS AND DISCUSSION:It was observed that physicians often find themselves confronted with conflicts between (a) trying to advocate for their individual patients versus (b) seeing the systemic perspective and understanding the global impact of their decisions at the same time. The groups agreed that due to the current shortage of donor organs in the German allocation system, transplanted patients are often too sick at the point of transplantation and that a better balance between urgency and effectiveness is needed. The aspects of 'effectiveness' and 'urgency' were identified as the most challenging issues and thus were the main focus of debate. The dilemmas physicians find themselves in become increasingly severe, the larger the shortage of suitable donor organs is.

The COVID-19 pandemic has introduced unique challenges to health-care systems worldwide. Organ procurement and transplantation activities were affected in this context as previously described by Alexandre Loupy and colleagues.1Loupy A Aubert O Reese PP Bastien O Bayer F Jacquelinet C Organ procurement and transplantation during the COVID-19 pandemic.Lancet. 2020; 395: e95-e96Summary Full Text Full Text PDF PubMed Scopus (215) Google Scholar However, COVID-19 and organ transplant data from Germany,2Rahmel A Organspende und Transplantation zu Beginn des Jahres 2020. Erste Erfahrungen zum Einfluss der SARS-CoV-2-Pandemie in Deutschland.https://www.dso.de/organspende/news-veranstaltungen/news/Organspende%2520und%2520SARS%2520COV-2/COVID-19-Epidemie/19Date: April 20, 2020Date accessed: October 21, 2020Google Scholar the Robert Koch Institute, and Eurotransplant paints a different picture. With the increase in the number of COVID-19 cases, organ procurement and transplantation activities in Germany remained robust (appendix).2Rahmel A Organspende und Transplantation zu Beginn des Jahres 2020. Erste Erfahrungen zum Einfluss der SARS-CoV-2-Pandemie in Deutschland.https://www.dso.de/organspende/news-veranstaltungen/news/Organspende%2520und%2520SARS%2520COV-2/COVID-19-Epidemie/19Date: April 20, 2020Date accessed: October 21, 2020Google Scholar Moreover, compared with the previous year, the cumulative numbers of deceased organ donors and transplants show no significant reduction. Kidney transplantation numbers were stable, while the numbers of heart, lung, and liver transplantations from deceased donors even increased from January to April, 2020, when compared with the same period of the previous year. In contrast, transplant activities in Italy and Spain were reduced by 30–50%.2Rahmel A Organspende und Transplantation zu Beginn des Jahres 2020. Erste Erfahrungen zum Einfluss der SARS-CoV-2-Pandemie in Deutschland.https://www.dso.de/organspende/news-veranstaltungen/news/Organspende%2520und%2520SARS%2520COV-2/COVID-19-Epidemie/19Date: April 20, 2020Date accessed: October 21, 2020Google Scholar We believe that this stability is highly related to adequate intensive care resources and largely benefits from the prophylactic measures and control strategy against COVID-19 in Germany. Elective surgeries were postponed or reduced. Therefore, the intensive care and ventilation resources could be allocated to organ procurement and transplantation during this crisis. In addition, a step-by-step plan and recommendations were applied in the early pandemic with close attention to the development and changes of the epidemic situation. The living donation programmes were only temporarily paused, whereas deceased organ donor transplants were continued throughout Germany. As a treatment to end-stage organ failure, transplantation should be regarded as an emergency treatment that should not be discontinued during a pandemic with a careful risk–benefit assessment. We declare no competing interests. Download .pdf (.18 MB) Help with pdf files Supplementary appendix Organ procurement and transplantation during the COVID-19 pandemicEnd-stage organ failure is estimated to affect more than six million people worldwide.1 In 2018, transplant systems across the world enabled around 150 000 patients to benefit from a kidney, heart, lung, liver, or other solid organ—a number far less than the demand. According to data from WHO , more than 1 500 000 people live with a transplanted organ worldwide. In the USA, approximately 40 000 patients receive an organ transplant every year, but 120 000 patients remain on a waiting list for transplantation, with 7600 individuals dying annually while waiting for an organ transplant. Full-Text PDF

In order to improve the demand-supply-mismatch in transplantation medicine, policy makers have to think about adapting existing legal frameworks for donor organ allocation. This study aims to systematically review preferences of physicians as well as patients in the field of transplantation medicine. PubMed, Web of Science, EBSCO and PsycINFO were searched from January 2000 to December 2018 without language restrictions. Fourteen publications were identified, six aiming at physicians, seven focusing on patients and one on both groups. The criteria used in these studies to elicit preferences can be grouped into six different main categories, all deriving from the general principle of equality: "Effectiveness/Benefit", "Medical urgency", "Own fault", "Social value", "Medical background" and "Socio-demographic status". Whilst patients on the one hand show a high demand for equal access, outcome maximization and punishment for damaging behaviors, they would still allocate organs to people with very low survival chances. Physicians decide against equal access to transplantation in cases where clinical evidence is weighed more heavily, e.g. in the cases of ethnicity and sex. Also, they seem more informed regarding the involvement of medical factors and give less importance to those with uncertain effects on transplantation outcome, such as tissue or blood group match. It is important to continuously monitor preferences of all involved stakeholders in order to achieve fair and accessible transplantation systems. (C) 2019 Elsevier Inc. All rights reserved.

Background Deceased donor organs are scarce resources because of a large supply-and-demand mismatch. This scarcity leads to an ethical dilemma, forcing priority-setting of how these organs should be allocated and whom to leave behind. Objective To explore public preferences for the allocation of donor organs in regard to ethical aspects of distributive justice. Methods Focus groups were facilitated between November and December 2018 at Hannover Medical School. Participants were recruited locally. Transcripts were assessed with content analysis using the deductive framework method. All identified and discussed criteria were grouped according to the principles of distributive justice and reported following the COREQ statement. Results Six focus groups with 31 participants were conducted. Overall, no group made a final decision of how to allocate donor organ; however, we observed that not only a single criterion/principle but rather a combination of criteria/principles is relevant. Therefore, the public wants to allocate organs to save as many lives as possible by both maximizing success for and also giving priority to urgent patients considering the best compatibility. Age, waiting time, reciprocity and healthy lifestyles should be used as additional criteria, while sex, financial status and family responsibility should not, based on aspects of equality. Conclusions All participants recognized the dilemma that prioritizing one patient might cause another one to die. They discussed mainly the unclear trade-offs between effectiveness/benefit and medical urgency and did not establish an agreement about their importance. The results suggest a need of preference studies to elucidate public preferences in organ allocation.

In order to improve the demand-supply-mismatch in transplantation medicine, policy makers have to think about adapting existing legal frameworks for donor organ allocation. This study aims to systematically review preferences of physicians as well as patients in the field of transplantation medicine. PubMed, Web of Science, EBSCO and PsycINFO were searched from January 2000 to December 2018 without language restrictions. Fourteen publications were identified, six aiming at physicians, seven focusing on patients and one on both groups. The criteria used in these studies to elicit preferences can be grouped into six different main categories, all deriving from the general principle of equality: "Effectiveness/Benefit", "Medical urgency", "Own fault", "Social value", "Medical background" and "Socio-demographic status". Whilst patients on the one hand show a high demand for equal access, outcome maximization and punishment for damaging behaviors, they would still allocate organs to people with very low survival chances. Physicians decide against equal access to transplantation in cases where clinical evidence is weighed more heavily, e.g. in the cases of ethnicity and sex. Also, they seem more informed regarding the involvement of medical factors and give less importance to those with uncertain effects on transplantation outcome, such as tissue or blood group match. It is important to continuously monitor preferences of all involved stakeholders in order to achieve fair and accessible transplantation systems. (C) 2019 Elsevier Inc. All rights reserved.

Introduction: Transplantation is the treatment of choice for organ failure, but deceased donor organs are a scarce resource because of a large supply and demand-mismatch. This scarcity leads to an ethical dilemma, forcing priority setting in organ allocation to wait-listed patients. To date, little is known about public preferences regarding priority setting in organ allocation. We explore public preferences for the allocation of donor organs in Germany. The aims are to determine criteria and preferences for the allocation and to elucidate the relative importance of different criteria. A systematic review and focus group discussions were conducted as preliminary works in regard to ethical aspects of distributive justice. Materials and Methods: To investigate the preferences we use a discrete choice experiment (DCE). According to the ISPOR guidelines we use both an overview of the existing evidence and qualitative methods to design the upcoming DCE. The systematic review contained literature from the databases PubMed, Web of Science, EBSCO and PsycINFO between January 2000 and December 2018. Only original studies were selected. The criteria were identified, extracted and grouped into a self-developed matrix according to the principles of distributive justice to ascertain public preferences. The focus groups were facilitated between November and December 2018 at Hannover Medical School. Participants were recruited locally. Transcripts were assessed with content analysis using the deductive framework method. Reporting followed the COREQ statement. Results and Discussion: Overall, 9,645 references were identified, and 15 studies were included in the review. In total, 27 criteria clustered in seven theory-guided groups could be identified: “equality”, “effectiveness/benefit”, “medical urgency”, “own fault”, “value for society”, “medical background” and “sociodemographic status”. It was shown that not only a single principle but rather a combination of principles are relevant for the allocation. Therefore, a public propensity towards a rational utilitarian ethical model of allocation could be recognized. Six focus groups with 31 participants were conducted. Overall, no group made a final decision of how to allocate donor organs. The public wants to allocate organs to save as many lives as possible by both maximizing the success and also giving priority to urgent patients considering the best compatibility. Age, waiting time, reciprocity and healthy lifestyles should be used as additional criteria, while sex, financial status and family responsibility should not, based on equality. Conclusion: The two preliminary works delivered important aspects for the design of the upcoming DCE. Public preferences for organ allocation are complex and data regarding clear trade-offs are still lacking. We expect that the results of the DCE allow a better understanding of public preferences and contribute to influence the organ allocation policy. This study was funded by the German Federal Ministry of Education and Research (Grant no.: 01EH1603B). The funding source had no role in the study and no influence on the data collection and analyses, interpretation of the results or writing of the publication.

Zusammenfassung In Deutschland herrscht eine anhaltende Organknappheit. Daraus resultiert die notwendige Priorisierung möglicher Organempfänger nach verschiedenen Prinzipien der Verteilungsgerechtigkeit, die abhängig von den Präferenzen relevanter Stakeholder sind (Allgemeinbevölkerung, Ärzteschaft und Patient/innen). Präferenzmessungen bieten die Möglichkeit die Qualitätsentwicklung und -sicherung im Allokationsprozess nachhaltig zu verbessern und die Akzeptanz des Allokationssystems qualitativ zu stärken.

Background Solid organ transplantation is the treatment of choice for organ failure, but donor organs are a scarce resource because of a large mismatch between supply and demand. This scarcity leads to an ethical dilemma, forcing priority setting in organ allocation to individual patients. Little is known about public preferences regarding priority setting in organ allocation. A systematic review was performed to review the existing evidence and provide an overview of the criteria and criterion levels in regard to ethical aspects of distributive justice. Methods The PubMed, Web of Science, EBSCO and PsycINFO databases were searched for literature published between January 2000 and December 2018. Only original studies were selected. The criteria were identified, extracted and grouped into a self-developed matrix according to the principles of distributive justice to ascertain public preferences. Results Overall, 9645 references were identified, and 15 studies were included. In total, 27 criteria clustered in seven theory-guided groups could be identified: “equality”, “effectiveness/benefit”, “medical urgency”, “own fault”, “value for society”, “medical background” and “sociodemographic status”. It was shown that not only a single principle but rather a combination of principles are relevant for the allocation. Therefore, a public propensity towards a rational utilitarian ethical model of allocation could be recognised. Conclusions The general public not only wanted to allocate organs mainly to those with a good probability of having a successful transplantation but also wanted to consider those who need an organ most urgently to prevent fatal consequences, resulting in unclear trade-offs between effectiveness/benefit and medical urgency. Public preferences for organ allocation are therefore complex, and data regarding clear trade-offs are still lacking.

Die Anforderungen an den Rehabilitationssektor werden durch den demografischen Wandel zukünftig weiter steigen. Bei begrenzten Budgets ist der effiziente Einsatz der Ressourcen prioritär. Um Entscheidungen über den optimalen Umfang und die optimale Ausgestaltung der Rehabilitation zu unterstützen, sind gesundheitsökonomische Studien in hohem Maß relevant. Der vorliegende Beitrag gibt einen Überblick über die gesundheitsökonomische Evaluation der Rehabilitation in Deutschland.