A Rational Reconstruction of Expert Judgments in Organ Allocation

The Eurotransplant Kidney Allocation System (ETKAS) emerged from the XCOMB model by Wujciak and Opelz (1993a,b), who applied computer simulation studies to create an allocation algorithm. The present study investigated how experts would allocate a donated organ to patients on the waiting list with respect to the five allocation factors proposed in the ETKAS (number of mismatches, mismatch probability, waiting time, distance, international exchange balance). The experts’ evaluations were compared to the ETKAS points as well as to factor weights established in mandatory allocation guidelines which are based on the German law for organ allocation (Transplantationsgesetz). The investigation was carried out using a conjoint analysis. Overall, the results indicate a fairly high degree of agreement between the experts’ opinions and the existing allocation system ETKAS and even more so for the allocation guidelines, in particular, with respect to the factors Mismatches, Mismatch probability, and Waiting time.