The Impact of Proposed Changes in Liver Allocation Policy on Cold Ischemia Times and Organ Transportation Costs

Abstract

Changes to the liver allocation system have been proposed to decrease regional variation in access to liver transplant. It is unclear what impact these changes will have on cold ischemia times (CITs) and donor transportation costs. Therefore, we performed a retrospective single center study (2008–2012) measuring liver procurement CIT and transportation costs. Four groups were defined: Local-within driving distance (Local-D, n = 262), Local-flight (Local-F, n = 105), Regional-flight <3 h (Regional <3h, n = 61) and Regional-Flight >3 h (Regional >3h, n = 53). The median travel distance increased in each group, varying from zero miles (Local-D), 196 miles (Local-F), 384 miles (Regional <3 h), to 1647 miles (Regional >3 h). Increasing travel distances did not significantly increase CIT until the flight time was >3 h. The average CIT ranged from 5.0 to 6.0 h for Local-D, Local-F and Regional <3h, but increased to 10 h for Regional >3h (p < 0.0001). Transportation costs increased with greater distance traveled: Local-D $101, Local-F $1993, Regional <3h $8324 and Regional >3 h $27 810 (p < 0.0001). With proposed redistricting, local financial modeling suggests that the average liver donor procurement transportation variable direct costs will increase from $2415 to $7547/liver donor, an increase of 313%. These findings suggest that further discussion among transplant centers and insurance providers is needed prior to policy implementation.

Geographic Disparities in Liver Availability: Accidents of Geography, or Consequences of Poor Social Policy?

“…Some raise methodological concerns, including uncertainty inherent to the models (6). Others predict increased cost associated with broader transporting both organs and transplant teams (7). Others predict increased cost associated with broader transporting both organs and transplant teams (7).…”

PRO: Redistricting of United Network for Organ Sharing Regions to Improve Geographic Disparities in Liver Transplantation

“…In another study, regional sharing of organs resulted in increased CIT compared with local sharing (7.0 versus 6.0 hours), although remaining below the 10‐hour threshold . In a single‐center study, 3‐year survival was similar between recipients of local and regional donors …”

Fair is fair: We must re-allocate livers for transplant

“…Some costs would likely rise under the new proposal, specifically transportation, and particularly for transplant programs in areas with lower median MELD scores [17]. But this cost is offset by savings in transplant-associated care, and by the value of saving additional lives.…”