“It’s not necessarily science based”: understanding organ utilisation decision-making in cardiothoracic transplantation in the UK through qualitative interviews

Objectives This study explores decision-making in organ transplantation. The number of patients waiting for a solid organ transplant continues to rise despite efforts to increase the available pool of donor organs. This has focused attention on maximising the number of organs offered that are subsequently transplanted, a process termed organ utilisation. There is a paucity of work exploring how clinicians decide to decline or accept offers of donor organs. This study aims to better understand the factors that influence organ utilisation decision-making in cardiac and thoracic transplantation through qualitative methods. Design Semi-structured qualitative interviews undertaken online over a 5-month period. Data collection and analysis occurred simultaneously. Transcripts were inductively analysed to generate themes. Setting Clinicians representing all six adult UK cardiothoracic transplant centres. Participants Consultant cardiothoracic transplantation surgeons (n=9) and cardiothoracic transplant coordinators (n=10). Results 19 interviews were undertaken. The following themes pertinent to utilisation decision-making were identified: anticipation of outcomes; data; motivation; out-of-hours; micro-culture and experiential learning . Conclusions This study is the first to explore the process of organ utilisation decision-making from a clinician’s perspective through interviews. This documents an important and nuanced understanding of the interrelated factors involved in utilisation decision-making in practice. By providing evidence for the human inconsistencies in utilisation decision-making, this work may inform a more considered approach to strategies to improve utilisation rates.