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Peer-reviewedCC BY 4.0BMJ Open

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

  • Rebeka Jenkins1,2
  • Gillian Hardman1,2
  • Karen Booth3
  • John Dark4
  • Andrew Fisher3,4
  • Catherine Exley1
4 affiliations
  1. 1Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
  2. 2Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
  3. 3Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  4. 4Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
Open at sourcePDFDOICite

Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{jenkins2026necessarily,
  title = {{“It’s not necessarily science based”: understanding organ utilisation decision-making in cardiothoracic transplantation in the UK through qualitative interviews}},
  author = {Rebeka Jenkins and Gillian Hardman and Karen Booth and John Dark and Andrew Fisher and Catherine Exley},
  journal = {BMJ Open},
  year = {2026},
  month = oct,
  doi = {10.1136/bmjopen-2026-121139},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121139},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - “It’s not necessarily science based”: understanding organ utilisation decision-making in cardiothoracic transplantation in the UK through qualitative interviews
AU  - Rebeka Jenkins
AU  - Gillian Hardman
AU  - Karen Booth
AU  - John Dark
AU  - Andrew Fisher
AU  - Catherine Exley
PY  - 2026
DA  - 2026/10/05
JO  - BMJ Open
DO  - 10.1136/bmjopen-2026-121139
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121139
AB  - 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.
SN  - 2044-6055
SN  - 2044-6055
ER  -