Cost Evaluation of a Donation after Cardiac Death Program: How Cost per Organ Compares to Other Donor Types

Lindemann, Jessica; Dageforde, Leigh Anne; Vachharajani, Neeta; Stahlschmidt, Emily; Brockmeier, Diane; Wellen, Jason R.; Khan, Adeel; Chapman, William C.; Doyle, M.

doi:10.1016/j.jamcollsurg.2018.02.005

Cited by 17 publications

(30 citation statements)

References 12 publications

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“…Increasing distance and requisite time expenditures among DCD procurements may act as disincentives to DCD liver offer acceptance among transplant surgeons. This surgeon time and opportunity cost are compounded by increased costs to the transplant center for transportation, personnel, and recipient admissions during unsuccessful procurements that do not ultimately generate revenue via transplant reimbursement …”

Section: Discussionmentioning

confidence: 99%

“…Donation after circulatory death (DCD) liver transplantation (LT) has increased slowly in the United States over the past decade, from 409 transplants in 2008 to 764 in 2018 . In part, this modest growth may be due to increased surgeon and center resource utilization for DCD LT compared to donation after brain death (DBD) LT, including lower procurement rates for DCD donors and higher center costs per successful procurement . Given that transplant surgeons generally determine liver offer acceptance, understanding surgeon incentives and disincentives is paramount.…”

Section: Introductionmentioning

confidence: 99%

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Going the distance for procurement of donation after circulatory death livers for transplantation—Does reimbursement reflect reality?

Montgomery

Highet

Hobeika

et al. 2020

Clinical Transplantation

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Donation after circulatory death (DCD) liver transplantation (LT) has increased slowly over the past decade. Given that transplant surgeons generally determine liver offer acceptance, understanding surgeon incentives and disincentives is paramount. The purpose of this study was to assess aggregate travel distance per successful DCD versus deceased after brain death (DBD) liver procurement as a surrogate for surgeon time expenditure and opportunity cost. All consecutive liver offers made to Michigan Medicine from 2006 to 2017 were analyzed. Primary outcome was the summative travel distance (spent on all attempted procurements) per successful liver procurement that resulted in LT. Donation after circulatory death liver offer acceptance was lower than DBD liver offers, as was proportion of successful procurements among accepted offers. Overall, 10 275 miles were travelled for accepted DCD liver offers, resulting in 23 successful procurements (mean 447 miles per successful DCD liver procurement). For accepted DBD liver offers, 197 299 miles were travelled, resulting in 863 successful procurements (mean 229 miles per successful DBD liver procurement). On average, each successful DCD liver procurement required 218 more miles of travel than each successful DBD liver procurement. Current reimbursement policies poorly reflect increased surgeon travel (and time) expenditures between DCD and DBD liver offers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Going the distance for procurement of donation after circulatory death livers for transplantation—Does reimbursement reflect reality?

Montgomery

Highet

Hobeika

et al. 2020

Clinical Transplantation

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“…The OPO is responsible for all potential donor costs once consented for organ donation including ICU care, operating room (OR) fees, imaging, procedures, lab testing and so forth, and this cost varies greatly between donors and hospitals. Overall, the cost per organ from a DCD is 60% higher than from a DBD (39).…”

Section: Challenges To Organ Recovery From Cdcdsmentioning

confidence: 94%

“…An additional concern regarding cDCDs is cost and organ yield (38). Nationally, more than half of evaluated DCDs do not yield transplantable organs and the organ yield per DCD is approximately 1.93 as compared to 3.25 for DBDs (39). The OPO is responsible for all potential donor costs once consented for organ donation including ICU care, operating room (OR) fees, imaging, procedures, lab testing and so forth, and this cost varies greatly between donors and hospitals.…”

Section: Challenges To Organ Recovery From Cdcdsmentioning

confidence: 99%

Donation after circulatory death donors in lung transplantation

Egan¹,

Haithcock²,

Lobo³

et al. 2021

J Thorac Dis

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Transplantation of any organ into a recipient requires a donor. Lung transplant has a long history of an inadequate number of suitable donors to meet demand, leading to deaths on the waiting list annually since national data was collected, and strict listing criteria. Before the Uniform Determination of Death Act (UDDA), passed in 1980, legally defined brain death in the U.S., all donors for lung transplant came from sudden death victims [uncontrolled Donation after Circulatory Death donors (uDCDs)] in the recipient's hospital emergency department. After passage of the UDDA, uDCDs were abandoned to Donation after Brain Death donors (DBDs)-perhaps prematurely. Compared to livers and kidneys, many DBDs have lungs that are unsuitable for transplant, due to aspiration pneumonia, neurogenic pulmonary edema, trauma, and the effects of brain death on lung function. Another group of donors has become available-patients with a devastating irrecoverable brain injury that do not meet criteria for brain death. If a decision is made by next-of-kin (NOK) to withdraw life support and allow death to occur by asphyxiation, with NOK consent, these individuals can have organs recovered if death occurs relatively quickly after cessation of mechanical ventilation and maintenance of their airway. These are known as controlled Donation after Circulatory Death donors (cDCDs). For a variety of reasons, in the U.S., lungs are recovered from cDCDs at a much lower rate than kidneys and livers. Ex-vivo lung perfusion (EVLP) in the last decade has had a modest impact on increasing the number of lungs for transplant from DBDs, but may have had a larger impact on lungs from cDCDs, and may be indispensable for safe transplantation of lungs from uDCDs. In the next decade, DCDs may have a substantial impact on the number of lung transplants performed in the U.S. and around the world.

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“…Potential DCD donors who did not advance to donation would be an example. 12 We estimated the number of potential donors indirectly by numbers of eligible deaths at each OPO and included it as a covariate in the model. To account for differences in geography and patient population, we included covariates based on our previous work, 14 including year, local price index, and donor case-mix.…”

Section: Cost Functionmentioning

confidence: 99%

The organ procurement costs of expanding deceased donor organ acceptance criteria: Evidence from a cost function model

Cheng

Held

Dor

et al. 2021

American Journal of Transplantation

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The shortage of available organs represents a large public health crisis worldwide, including in the United States. 1 One solution is to expand living donation for organs where possible. Another solution is to expand deceased donor organ utilization. The expansion of deceased donor criteria has been an active area of recent research. Comparative studies between the United States and other developed countries including the United Kingdom, Spain, and France have shown that nonstandard donors, including older donors and donation after cardiac death (DCD) donors, are underutilized in the United States, despite evidence showing acceptable transplant outcomes. 2-4 From 2006 through 2018, the use of kidneys from donors age 65 and older remained stagnant below 10%, and discard rates for "lower quality" kidneys (as measured by the Kidney Donor Profile Index [KDPI] >85) remain high at 60%, 5 representing a large

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Cost Evaluation of a Donation after Cardiac Death Program: How Cost per Organ Compares to Other Donor Types

Cited by 17 publications

References 12 publications

Going the distance for procurement of donation after circulatory death livers for transplantation—Does reimbursement reflect reality?

Going the distance for procurement of donation after circulatory death livers for transplantation—Does reimbursement reflect reality?

Donation after circulatory death donors in lung transplantation

The organ procurement costs of expanding deceased donor organ acceptance criteria: Evidence from a cost function model

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