Prioritizing patients for renal transplantation?: Analysis of patient preferences for kidney allocation according to ethnicity and gender

Revisions to UK transplant allocation policy in 2006 marked a policy shift towards ascribing higher priority to people who had been waiting for a long time for transplants, and to young adults, at the expense of emphasising tissue match between donor and recipient. This benefited members of ethnic minorities because of a shortage of donors from some ethnic groups. However, the change was informed by dated research which was not specific to the UK, and which failed to address ethnic or gender-related differences in preferences. Preference information was elicited using discrete choice experiment (DCE) questionnaires (in English, Punjabi, Hindi, Bengali, Gujarati and Urdu) from 908 patients (508 males and 397 females). Of the 908 repondents, 96 were members of ethnicminority groups, namely white ethnic minorities (27/908) and non-white ethnic minorities (69/908), including 50 South Asians. Priority criteria included length of time spent waiting for a transplant, quality of the donor-recipient tissue match, number of adult and/or child dependants of the recipient, and whether the recipient had diseases that affected their life expectancy or quality of life. Econometric results provided evidence that preferences differed slightly according to gender, but differed to a greater extent according to ethnic origin. In significant contrast to other patients, members of non-white and South Asian ethnic minorities did not tend to prioritise recipients with a good tissue match, nor, unlike patients more generally, did they tend to prioritise younger recipients. Non-white and South Asian ethnic minorities were also less likely to prioritise those with moderate rather than severe diseases affecting life expectancy. These results reinforce the case for recognising differences in ethnic-minority group preferences in transplant allocation policy.