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Organ Donor Priorities Shift When Recipients Are Seen as Individuals, Study Finds

When given opportunity to choose case by case, people put those who could benefit most first on the list

kidney transfer

Who should get a “new” kidney when a donor organ is available is always a difficult decision. Should it go to the person who’s been waiting longest, or someone who can benefit most?

A new series of studies coauthored by a pair of Rutgers University researchers has shed new light on what the public thinks about making this kind of tradeoff: People are more likely to give priority to patients who are in the greatest need of a new kidney if they see the patients as individuals, rather than as members of a group.

The study’s authors say their research could prove useful to policymakers as they refine how organs are distributed nationally.

Deciding on these priorities has long been a challenge for the national Organ Procurement and Transplantation Network, which last year made changes that are intended to help ensure that organs are given to those who would benefit the most.

This study suggests the organ network could go even further in that direction without prompting a public backlash.

The Rutgers research, recently published in the journal Psychological Science, included a series of three hypothetical exercises that asked participants to set priorities on which of 12 patients would receive six available kidneys.

In one study, the hypothetical patients were divided into two groups: six patients who had a high chance of success if they received a kidney, and six who had a low chance of success.

When study participants (who signed up through a research website) were asked to divide the kidneys between those two groups, they tended to give some to each group. But when they were forced to choose who received the kidneys on an individual basis, they were more likely to give more of the kidneys to those who could benefit the most.

The other two studies looked at whether participants were more likely to give kidneys to those who could benefit the most if they were seen as part of a group of similar patients or as one in a general pool of patients. Again, these studies found that those who could benefit most were more likely to be chosen if the participants saw them as individuals.

The research is significant, the authors say, because it was the first study of its kind that encouraged participants to consider possible kidney recipients as individuals. And this could have significant implications for those who decide organ allocation policies, since earlier studies had found that the public was more interested in being fair to members of different groups -- such as those who wait a long time for kidneys – rather than focusing on those who could benefit most.

Gretchen Chapman, a Rutgers psychology professor and coauthor, said she was interested in doing the study because she had “a strong intuition” that the earlier studies had missed something.

“Maybe the preference wasn’t so stable, maybe the prior research wasn’t giving the full view of individuals’ preference,” said Chapman, who co-wrote the paper with Rutgers psychology doctoral student Jeff DeWitt and University of California, Los Angeles, researcher Helen Colby.

DeWitt said that the study results might make policymakers less fearful of sparking public outcry if they put more weight on giving kidneys to those who would benefit the most.

“They need the public to actually buy into the organ donation system,” he noted.

But both coauthors agreed that there should always be a place for the idea of fairness in the organ-donation system. For example, they said, the amount of time that patients have waited for a kidney should continue to be a factor in when they receive one.

Chapman said she’s interested in doing a similar study that would look at whether a decision that’s often made on an individual basis -- such as which employees at a company receive a raise -- would be made with a greater emphasis on fairness if the employees were presented as members of groups. For instance, would an employer be more likely to give raises equally to men and women if they saw them labeled as members of the groups “men” and “women,” rather than as individuals?

“Any time there’s a tradeoff in a decision, it’s interesting to look at how people are making that tradeoff,” she said.

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