The Cost of Procuring Deceased Donor Kidneys

Evidence From OPO Cost Reports 2013-2017

Philip J. Held; Jennifer L. Bragg-Gresham; Thomas Peters; Glen M. Chertow; Frank McCormick; John P. Roberts

Disclosures

American Journal of Transplantation. 2020;20(4):1087-1094. 

In This Article

Abstract and Introduction

Abstract

Using 5 years of US organ procurement organization (OPO) data, we determined the cost of recovering a viable (ie, transplanted) kidney for each of 51 OPOs. We also examined the effects on OPO costs of the recovery of nonviable (ie, discarded) kidneys and other OPO metrics. Annual cost reports from 51 independent OPOs were used to determine the cost per recovered kidney for each OPO. A quadratic regression model was employed to estimate the relationship between the cost of kidneys and the number of viable kidneys recovered, as well as other OPO performance indicators. The cost of transplanted kidneys at individual OPOs ranged widely from $24 000 to $56 000, and the average was $36 000. The cost of a viable kidney tended to decline with the number of kidneys procured up to 549 kidneys per year and then increase. Of the total 81 401 kidneys recovered, 66 454 were viable and 14 947 (18.4%) were nonviable. The costs of kidneys varied widely over the OPOs studied, and costs were a function of the recovered number of viable and nonviable organs, local cost levels, donation after cardiac death, year, and Standardized Donor Rate Ratio. Cost increases were 3% per year.

Introduction

The 58 US organ procurement organizations (OPOs) are not-for-profit entities with a federal contract to cover a specific geographic area over which the OPO is granted exclusive responsibilities, that is, a monopoly. Required OPO tasks include assessment of potential organ donors, obtaining consent for organ donation from next of kin, surgical recovery and preservation of viable organs, and transport of organs to transplant center hospitals. Allocation of any organ to a specific recipient is directed through the Organ Procurement Transplantation Network (OPTN) and the United Network for Organ Sharing (UNOS), which holds the federal contract from the OPTN. Transplant center professionals make the final decision to accept and transplant or reject and discard any individual organ.

Whereas the costs for most aspects of the organ transplant process have been reported,[1–3] the functional OPO cost, generally referred to as the organ acquisition cost (OAC), has not been widely researched.[4] As a consequence of the National Organ Transplantation Act (NOTA),[5] OPOs have a defined method of assessing OAC, and the aggregate costs incurred by any OPO are unique to that OPO. Because all areas of the United States are the responsibility of some OPOs, there are many potential variations in expenses including local labor costs, the number of potential and actual donors, the number of transplant hospitals in the OPO service area, hospital charges for maintaining donor organ function after brain death (prior to organ recovery), and other costs.

Among US OPOs, the number of kidneys recovered annually varies from fewer than 100 to over 800 kidneys procured and transplanted. In this analysis, we have sought to describe variations in kidney procurement costs across the United States and differences in kidney cost by OPO size (hereafter defined by the number of kidneys procured annually). Kidney acquisition costs related to transplanted (viable) organs and of those related to discarded, "nonviable" kidneys (ie, organs recovered for transplantation but not transplanted) on cost and OPO outcomes were also examined. Understanding cost variations among US OPOs could allow for pragmatic assessments regarding OPO efficiency, economies of scale, and other matters related to policy issues affecting OPOs and the patients ultimately served.

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