Allocation of Mechanical Ventilators During a Pandemic: A Mixed-Methods Study of Perceptions among Japanese Health Care Workers and the General Public.

ABSTRACT Background In Japan, public dialog on allocation of life-saving medical resources remains taboo, and discussion has largely been avoided. Research Question Do Japanese health care workers and the general public agree with principles of ventilator allocation developed internationally? Study Design and Methods A 4-point Likert scale questionnaire was used to assess the extent of agreement or disagreement with internationally developed triage principles for rationing mechanical ventilators during pandemics. Questionnaires were distributed in person or online, and generalized linear models were used to analyze quantitative data. Free-text descriptions were qualitatively analyzed, both deductively and inductively, to compare respondent opinions with those described in previous US studies. Results Of 3191 surveys distributed, 1520 were returned. Allocation of resources to maximize survival from current illness (“save the most lives”) was the most popular triage principle, with 95.8% of respondents in agreement. Allocation to ensure a minimum duration of benefit, as determined by predicted post-illness prognosis (“ensure minimum duration of benefit”), and allocation to persons who have experienced fewer life stages (“life cycle”) obtained agreement of 82.2% and 80.1%, respectively. Withdrawal and reallocation of mechanical ventilators to more appropriate patients was supported by 64.4% of respondents. Only 29.4% of respondents supported the principle of first-come, first-served access to ventilators. Interpretation Most respondents supported allocation principles developed internationally and disagreed with the idea of first-come, first-served allocation during resource shortages. The Japanese public seems to be largely prepared to discuss the ethical dilemmas and possible solutions regarding fair and transparent allocation of critical-care resources as a necessary step in confronting present and future pandemics and disasters.