Resource Utilization Associated With Procurement of Transplantable Organs From Donors That Do Not Meet OPTN Eligible Death Criteria

DuBay, Derek A.1,6; Redden, David T.2; Bryant, Mary K.1; Dorn, David P.1; Fouad, Mona N.3; Gray, Stephen H.1; White, Jared A.1; Locke, Jayme E.1; Meeks, Christopher B.4; Taylor, Garry C.4; Kilgore, Meredith L.5; Eckhoff, Devin E.1

Transplantation:
doi: 10.1097/01.TP.0000441093.32217.cb
Clinical and Translational Research
Abstract

Background: The strategy of evaluating every donation opportunity warrants an investigation into the financial feasibility of this practice. The purpose of this investigation is to measure resource utilization required for procurement of transplantable organs in an organ procurement organization (OPO).

Methods: Donors were stratified into those that met OPTN-defined eligible death criteria (ED donors, n=589) and those that did not (NED donors, n=703). Variable direct costs and time utilization by OPO staff for organ procurement were measured and amortized per organ transplanted using permutation methods and statistical bootstrapping/resampling approaches.

Results: More organs per donor were procured (3.66±1.2 vs. 2.34±0.8, P<0.0001) and transplanted (3.51±1.2 vs. 2.08±0.8, P<0.0001) in ED donors compared with NED donors. The variable direct costs were significantly lower in the NED donors ($29,879.4±11590.1 vs. $19,019.6±7599.60, P<0.0001). In contrast, the amortized variable direct costs per organ transplanted were significantly higher in the NED donors ($8,414.5±138.29 vs. $9,272.04±344.56, P<0.0001). The ED donors where thoracic organ procurement occurred were 67% more expensive than in abdominal-only organ procurement. The total time allocated per donor was significantly shorter in the NED donors (91.2±44.9 hr vs. 86.8±78.6 hr, P=0.01). In contrast, the amortized time per organ transplanted was significantly longer in the NED donors (23.1±0.8 hr vs. 36.9±3.2 hr, P<0.001).

Discussion: The variable direct costs and time allocated per organ transplanted is significantly higher in donors that do not meet the eligible death criteria.

Author Information

1 Division of Abdominal Transplant, University of Alabama at Birmingham, Birmingham, AL.

2 School of Public Health–Biostatistics, University of Alabama at Birmingham Birmingham, AL.

3 Preventive Medicine, University of Alabama at Birmingham Birmingham, AL.

4 Alabama Organ Center, Health Services Foundation, Birmingham, Alabama.

5 School of Public Health–Health Care Organization and Policy, University of Alabama at Birmingham Birmingham, AL.

6 Address correspondence to: Derek A. DuBay, M.D., Division of Transplantation University of Alabama at Birmingham ZRB 701, 1530 3rd Ave, S Birmingham, AL 35294-0007.

This research was supported by a grant from the University of Alabama at Birmingham Health Services Foundation (to D.A.D.), a Charles Barkley Research Award (to D.A.D.), and NIH NIDDK 1 K23 DK091514 (to D.A.D.).

The authors declare no conflicts of interest.

E-mail: ddubay@uab.edu

D.A.D participated in the design, research, and writing of the manuscript. S.H.G., J.A.W. and D.E.E. participated in the design and writing of the manuscript. J.E.L. participated in the analysis and writing of the manuscript. D.T.R. participated in the analysis. M.N.F., C.B.M., and G.C.T. participated in the analysis and writing of the manuscript. M.L.K. participated in the design, analysis, and writing of the manuscript.

Received 8 April 2013. Revision requested 30 April 2013.

Accepted 6 November 2013.

Accepted February 7, 2013

© 2014 by Lippincott Williams & Wilkins