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.

本研究旨在评估德国公众对捐赠器官分配的偏好，重点关注分配正义的伦理原则。我们使用自行完成的在线问卷进行了离散选择实验 (DCE)。在系统回顾和焦点小组讨论的基础上，选择了 6 个属性，每个属性有 2-4 个级别（括号内为对应的分配公平原则），包括（1）移植后获得的生命年数（分配公平原则：有效性/益处） – 功利主义），(2) 移植后的生活质量（有效性/益处 – 功利主义），(3) 提供进一步捐赠器官的机会（分配正义原则：医疗紧迫性 – 偏爱最差的人），(4) 年龄（医疗和社会风险因素：社会人口状况），(5) 注册捐赠者（分配公平原则：对社会的价值），以及（6）个人在导致器官衰竭中的作用（分配公平原则：自己的过错）。每个受访者都有八个选择集，并要求他们在没有选择退出的两个假设患者之间进行选择。使用条件 logit、混合 logit 和潜在类别模型分析数据。最终样本包括 1028 名受访者。选择决策受所有属性的显着影响，除了获得进一步捐赠器官的机会。移植后良好的生活质量、年龄较小和没有导致器官衰竭的个体作用等属性对选择决策的影响最大。移植后获得的生命年数和成为注册捐赠者对公众来说不那么重要。潜在类别模型确定了四个具有偏好异质性的类别。受访者更愿意根据与有效性/收益相关的标准来分配已故捐献器官，而医疗紧急程度则次之。因此，可以确定一种理性的、功利的、道德的分配模式的公众倾向。公众偏好可以帮助制定政策以保证对社会负责的分配系统，从而提高器官捐赠率。