Organ Donor Recovery Performed at an Organ Procurement Organization-Based Facility Is an Effective Way to Minimize Organ Recovery Costs and Increase Organ Yield

Doyle, Majella B.; Subramanian, Vijay; Vachharajani, Neeta; Collins, Kelly; Wellen, Jason R.; Stahlschmidt, Emily; Brockmeier, Diane; Coleman, Jason; Kappel, Dean F.; Chapman, William C.

doi:10.1016/j.jamcollsurg.2015.12.032

Cited by 43 publications

(53 citation statements)

References 11 publications

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“…2,9 There are currently 9 other OPCs in the United States, and the one in our Organ Procurement Organization (OPO) is the longest functioning center. 2,9 There are currently 9 other OPCs in the United States, and the one in our Organ Procurement Organization (OPO) is the longest functioning center.…”

Section: The Organ Procurement Center As a Potential Solutionmentioning

confidence: 99%

“…2,9 There are currently 9 other OPCs in the United States, and the one in our Organ Procurement Organization (OPO) is the longest functioning center. 2 To date, no donor families have rescinded authorization once consent to transport the donor has been given. 9 Following evaluation, the timing of procurement is coordinated with the recipient transplant teams.…”

Section: The Organ Procurement Center As a Potential Solutionmentioning

confidence: 99%

“…2,9 However, because of the Medicare cost report, organs procured at an OPC are not counted toward the Medicare organ ratio, leading to a loss in Medicare reimbursement. 2,9 However, because of the Medicare cost report, organs procured at an OPC are not counted toward the Medicare organ ratio, leading to a loss in Medicare reimbursement.…”

Section: The Organ Procurement Center As a Potential Solutionmentioning

confidence: 99%

“…Since 2001 when the OPC was established, our center noted a significant decrease in surgeon travel time, number of flights for organ procurements, increased predictability of procurements and transplants, significantly lower associated costs, and increased organ yield. 2,9 There are currently 9 other OPCs in the United States, and the one in our Organ Procurement Organization (OPO) is the longest functioning center. Details of the OPC facilities and donor transplant have been previously reported.…”

Section: The Organ Procurement Center As a Potential Solutionmentioning

confidence: 99%

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Organ procurement center allows for daytime liver transplantation with less resource utilization: May address burnout, pipeline, and safety for field of transplantation

Lindemann

Dageforde

Brockmeier³

et al. 2019

American Journal of Transplantation

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Abdominal organ transplantation faces several challenges: burnout, limited pipeline of future surgeons, changes in liver allocation potentially impacting organ procurement travel, and travel safety. The organ procurement center (OPC) model may be one way to mitigate these issues. Liver transplants from 2009 to 2016 were reviewed.There were 755 liver transplants performed with 525 OPC and 230 in-hospital procurements. The majority of transplants (87.4%) were started during daytime hours (5 am-7 pm). Transplants with any portion occurring after-hours were more likely to have procurements in-hospital (P < .001). Daytime cases (n = 400) had more OPC procured livers and hepatitis C recipients and were less likely to have a donation after circulatory death donor (all P < .05). In adjusted analyses, daytime cases were independently associated with extubation in the operating room and less postoperative transfusion. There were no significant differences in short-or long-term postoperative outcomes. For exported livers, 54.3% were procured by a local team, saving 137 flights (151 559 miles). The OPC resulted in optimally timed liver transplants and decreased resource utilization with no negative impact on patient outcomes. It allows for ease in exporting organs procured by local surgeons, and potentially addresses provider burnout, the transplant surgery pipeline, and surgeon travel. K E Y W O R D Sclinical research/practice, donors and donation: donor evaluation, editorial/personal viewpoint, education, liver transplantation/hepatology, organ procurement, organ procurement and allocation, organ procurement organization, organ transplantation in general | 1297 LINDEMANN Et AL. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Lindemann J, Dageforde LA, Brockmeier D, et al. Organ procurement center allows for daytime liver transplantation with less resource utilization: May address burnout, pipeline, and safety for field of transplantation.

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Section: The Organ Procurement Center As a Potential Solutionmentioning

confidence: 99%

Section: The Organ Procurement Center As a Potential Solutionmentioning

confidence: 99%

Section: The Organ Procurement Center As a Potential Solutionmentioning

confidence: 99%

Section: The Organ Procurement Center As a Potential Solutionmentioning

confidence: 99%

See 2 more Smart Citations

Organ procurement center allows for daytime liver transplantation with less resource utilization: May address burnout, pipeline, and safety for field of transplantation

Lindemann

Dageforde

Brockmeier³

et al. 2019

American Journal of Transplantation

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“…(14) Our efforts to increase organ donation must be the major focus of our current efforts, as some portions of the country have so effectively proven. (15) Implementation of redistricting will shift the attention of OPOs and transplant centers to logistics and will result in an overall decrease in liver transplants, as predicted by liversimulated allocation modeling. However, should we change the rules and alter the distribution for who gets the offer, are we not changing where the lifesaving chance exists, or as my patient said, "So you're wanting me to live long enough so I might get sick enough to win."…”

mentioning

confidence: 99%

The new lottery ticket: Share 35

Chapman¹

2016

Liver Transpl

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Although regional sharing for liver transplantation for acute liver failure has been accepted for more than 25 years, (1) its extension to decompensated cirrhosis has only more recently become widely adopted. (2) In the current issue of Liver Transplantation, Edwards et al. (3) detail the results of the first 2 years of Share 35 following its implementation by the United Network for Organ Sharing. As anticipated, a greater number of candidates underwent transplantation in the Model for End-Stage Liver Disease (MELD)/Pediatric End-Stage Liver Disease (PELD) 351 category, with minimal changes in posttransplant mortality, graft survival, and access for pediatric and minority patients. (4) So, should we, as do the authors, endorse the current, or an even wider implementation of this strategy?First, historical precedent suggests that regional organ sharing does not reduce wait-list mortality. Share 35 is not the first effort in regional sharing for high-MELD candidates. Region 8 implemented an even broader sharing agreement for a 4-year time interval (2007)(2008)(2009)(2010)(2011), sharing regionally for MELD 291 candidates. (5) An analysis of the data from this experience indicated that there was no overall reduction in wait-list mortality. Mortality reduction in the smaller group of higher MELD patients was offset by increased mortality of the much larger group of lower MELD patients. In addition, there was a marked increase in travel time and associated costs, without a net benefit.Second, the financial implications of expanded organ sharing are significant and are not assessed in the report. A limitation of the analyses performed to date has been that they have only considered that a regional share involves additional air charter expense compared with the cost of a local donor. (6,7) In fact, for many, including in our donor service area (DSA), the standard acquisition cost for a regional donor is double that of a local donor because not only is travel cost increased, but the rules by which organ procurement organizations (OPOs) operate lead to markedly increased charges for liver donors harvested from outside the DSA. (7) This calculation does not consider the significantly increased human capital expenditure for regional shares compared with a local donor or how increased travel introduces increased risk to the transplant teams. (8,9) There has been modeling to suggest that broader sharing would result in "minimal overall system cost" because sicker patients would be transplanted earlier.The first problem is that our system does not allow for savings in pretransplant care to accrue to transplant centers to offset significant increases in costs for transplantation and posttransplant care. This is a lofty idea, but even if it turned out to be true, we have no mechanism to allocate cost savings, for example, from an insurance carrier to the potential transplant center to offset policy-associated increases to overhead costs. Additionally, our allocation system is dynamic, and with Share 35, the number of people wai...

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The Impact of Donor Care Units—Caring Better and More Efficiently?

Lehr,

McCurry

2024

JAMA Netw Open

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Organ Donor Recovery Performed at an Organ Procurement Organization-Based Facility Is an Effective Way to Minimize Organ Recovery Costs and Increase Organ Yield

Cited by 43 publications

References 11 publications

Organ procurement center allows for daytime liver transplantation with less resource utilization: May address burnout, pipeline, and safety for field of transplantation

Organ procurement center allows for daytime liver transplantation with less resource utilization: May address burnout, pipeline, and safety for field of transplantation

The new lottery ticket: Share 35

The Impact of Donor Care Units—Caring Better and More Efficiently?

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