Eliminating Transplant Waiting Time Inequities - with an application to Kidney Allocation in the USA

AbstractExperts in the field of organ transplantation had to rank order a set of 32 patients according to their priority in receiving a donated kidney. The patients were described by the five characteristics that are incorporated in the kidney allocation algorithm applied by Eurotransplant. The priority rankings as defined by the experts were analyzed and patterns of dedsion making identified in the rankings investigated in this study. All patterns could be explained by some type of lexicographical ranking. The larger group of experts preordered tissue compatibility or, more technically speaking, the criterion of HLA match, while the complementary group applied the criterion of the length of waiting time first. Analyzing the finer decision structures of expert rankings and com paring the method of pattern exploration with a conjoint measurement analysis led to two follow-up questions: First, how can the value judgments of the experts be described adequately? Second, which type of aggregated ordering derived from the individual rankings represents them ‘best’?

Download Full-text

Distributive Justice in Kidney Allocation

Analyse & Kritik ◽

10.1515/auk-2001-0211 ◽

2001 ◽

Vol 23 (2) ◽

Cited By ~ 1

Author(s):

Thomas Schmidt

Keyword(s):

Renal Failure ◽

Distributive Justice ◽

Waiting Time ◽

Cadaveric Donor ◽

Kidney Allocation ◽

Allocation System ◽

Kidney Allocation System ◽

Basic Features

AbstractFor patients suffering from renal failure, cadaveric donor kidneys are a scarce and valuable good. In 1996, the Eurotransplant International Foundation implemented a new kidney allocation. system. The aim of this paper is to identify and discuss issues of distributive justice in kidney allocation, with an emphasis on the basic features of the new Eurotransplant system. Particular consideration is given to waiting time and medical success.

Download Full-text

Parental satisfaction with waiting time in a Swiss tertiary paediatric emergency department

Emergency Medicine Journal ◽

10.1136/emermed-2019-208616 ◽

2020 ◽

pp. emermed-2019-208616

Author(s):

Viola Löflath ◽

Eva-Maria Hau ◽

Daniel Garcia ◽

Steffen Berger ◽

Ruth Löllgen

Keyword(s):

Waiting Time ◽

Waiting Times ◽

Family Doctor ◽

Parental Satisfaction ◽

Parental Perception ◽

Paediatric Emergency ◽

Physician Contact ◽

The Usa ◽

Satisfaction With Treatment ◽

The Uk

IntroductionPatient numbers in paediatric emergency departments (PED) are steadily increasing. Parental perception of waiting time and reasons for attending a PED with non-emergencies have been investigated in the UK, Australia, Korea, Canada and the USA. We sought to examine which factors influence parental satisfaction with waiting time in a tertiary Swiss PED and whether these differed from other countries.MethodsPaper surveys were administered to parents of children presenting to our interdisciplinary PED from February to May 2015. Primary outcome was parental satisfaction with waiting time, secondary outcomes were satisfaction with treatment, parental reasons for presentation with non-emergencies, parental perception of times to triage, first physician contact and disposition from ED, level of physician training, understanding of various anticrowding strategies and comparison of perceived and true waiting times to triage and physician contact.Results739 out of 750 surveys were returned (57 complete, 298 with 1 or 2 missing answers). Satisfaction with waiting time (on a 5-point-Likert-scale; 1 being the best possible answer) was higher in groups with shorter waiting time until triage (+0.41, p=0.001), first physician contact (+1.43, p<0.001) and discharge (+0.71, p<0.001), higher triage category urgency (+0.47, p=0.044) and available entertainment (+0.82, p<0.001). Early first physician contact (+0.33, p=0.008) and time to discharge less than 4 hours (+0.37, p<0.001) was associated with greater satisfaction with treatment (p<0.05). The most frequent reasons for presentation were parental impression that the child had an emergency (n=265, 35.9%) and referral by the family doctor (n=245, 33.2%).ConclusionTo counteract parental dissatisfaction associated with waiting time, we suggest the implementation of feasible measures including entertainment while waiting, early first medical review and timely discharge from the PED.

Download Full-text