Health worker's practices and perspectives on the allocation of solid organs based on Govind Persad et al. criteria: a case of Mulago Hospital

Abstract

Allocation of solid human organs is complex due to global scarcity amidst high demand necessitating transparent, equitable and efficient allocation policies. In Uganda, the absence of a formal organ distribution framework raises concerns about fairness and consistency in decision-making. This study explored the practices and perspectives of health workers in Uganda regarding organ allocation, guided by Govind Persad’s ethical criteria. A qualitative cross-sectional study was conducted with 15 health workers involved in organ transplant services at Mulago National Referral Hospital, Kampala. Key-informant interviews were audio-recorded, transcribed verbatim, and analyzed by two independent coders. Analysis was primarily deductive, guided by Ajzen’s Theory of Planned Behaviour and Persad et al.’s multi-principle framework, complemented by inductive analysis to capture emergent themes. NVIVO 14 software supported data management and organization. Four themes emerged: practices for organ transplant scheduling, attitudes towards organ allocation based on Persad’s ethical principles, perceived control and ethical dilemmas encountered. Current practices at Mulago Hospital are largely influenced by an institutional culture that prioritizes first-degree relatives identified by patients. Compatibility screening and psychosocial support are provided and standard operating procedures emphasize voluntarism, informed consent, and respect for religious values. Health workers expressed positive attitudes toward adopting global organ allocation models but emphasized the need for contextual adaptation. Perceived control over transplant scheduling was limited due to systemic constraints, including resource scarcity and infrastructure limitations, which negatively affect equity. Ethical dilemmas commonly arose from challenges in identifying familial coercion and managing emotional distress linked to transplant disqualifications or delays. Formal organ allocation frameworks are essential for promoting equity and transparency in transplant scheduling. Adjusting global allocation models to align with the resource, cultural, and systemic constraints represents a pragmatic approach to strengthening organ allocation practices at Mulago National Referral Hospital and similar resource-limited settings.