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Economic and financial outcomes in transplantation: whose dime is it anyway?

Axelrod, David A.

Current Opinion in Organ Transplantation: April 2013 - Volume 18 - Issue 2 - p 222–228
doi: 10.1097/MOT.0b013e32835f0757
REGULATORY, FINANCIAL AND ETHICAL CONSIDERATIONS IN TRANSPLANTATION: Edited by Anton I. Skaro

Purpose of review: Organ transplant is a resource-intensive service that has been subjected to increasing scrutiny in this era of cost containment. A detailed understanding of the economic (societal) and financial (transplant provider) implications of organ quality, recipient characteristics, and allocation policy is vital for the transplant professionals.

Recent findings: Prior studies of kidney transplant economics demonstrate significant cost savings achieved by eliminating the need for long-term dialysis. However, transplant providers are experiencing higher financial costs because of changes in recipient characteristics and broader use of marginal organs. Liver transplantation economics are also more challenging because of the severity of illness-based organ allocation. Furthermore, the use of more allografts recovered from donors after cardiac death has been demonstrated to increase costs with minimal benefits. Finally, successful long-term mechanical support devices have fundamentally changed the economic implications of advanced heart failure care.

Summary: Although care for end-stage organ failure through transplant is one of the landmark accomplishments of 20th century medicine, maintaining or expanding access to transplant care is threatened by the high cost of care. Novel strategies are vital to reduce the financial burden faced by the centers that transplant high-risk patients and utilize lower quality organs.

Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA

Correspondence to David A. Axelrod, MD, MBA, Associate Professor of Surgery, Section Chief, Solid Organ Transplant Surgery, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA. E-mail: david.a.axelrod@hitchcock.org

© 2013 Lippincott Williams & Wilkins, Inc.