ILTS 2012 Report – Casting wide net for donated livers is worthwhile

by Thomas R. Collins – Pursuing liver grafts in an aggressive manner throughout the United States is much more costly than getting them from a local or regional area, but those expenses are more than offset by the savings generated by transplanting patients earlier rather than later, according to a single-center study presented here at the 18^th International Congress of the International Liver Transplantation Society.

Researchers at the University of Chicago Medical Center came to the conclusion after examining their liver transplant records over a period of nearly two years from September of 2010 to April of 2012.

Few studies have examined, at the individual center level, the costs of obtaining donors nationally compared to regionally, even though the behaviours and tendencies of individual centres is important in determining the best use of resources in procuring organs, said John Renz, MD PhD, Director of the Liver Transplant Program at the centre.

How allografts are obtained — and who has access to organs from the widest area — continues to be a hot topic in the transplantation field.

“We all know that allocation is a very touchy and controversial subject in the United States,” said John Renz, MD PhD, Director of the Liver Transplant Program at the centre. “It certainly contributes at least in part to the geographic disparity with respect to allograft availability…. Whenever we talk about increasing the allocation, unit costs and outcomes are always thought to be a concern.”

With that in mind, researchers looked the details of the 44 transplants performed during the study period. Twenty-two of those were done using organs obtained outside the region and 22 using organs within the region.

They looked at costs such as logistics expenses, acquisition fees and surgical procurement fees, as well as nursing, anaesthesia, supplies and admissions cost for the recipients. Costs that are unmeasured, they noted, include organ procurement organization time and supplies, the time of the donor surgeon if no fee is charged, the time of the surgical team at the University of Chicago and the logistics on the recipient side.

To get to the 44 transplants, the transplant team reviewed 1,521 from DonorNet, an electronic organ availability system, and 217 offers from the organ procurement organization.

Researchers calculated how much it cost for each transplanted organ by dividing the total amount spent on evaluating organs and dividing by the number of transplanted organs. So if, say, $100,000 was spent evaluating 6 organs and 4 were transplanted, the cost per transplant would be $25,000.

They found that the cost per transplanted organ obtained from out-of-region sources cost 78 percent more than those obtained from regional sources. That amounted to 19 hospital-day equivalents for each allograft.

But that sum, Dr Renz said, was worth it.

“The out-of-region allografts cost more but that cost is minor compared to the savings you get due to transplanting the patient earlier,” he said.

Outcomes for the recipients were similar for national and regional grafts. There was one death among the regionally obtained grafts and two among those obtained nationally.

But there was a higher complication rate — 45 percent to 32 percent — and a longer length of hospital stay — 15 days compared to 20 — for the out-of-region group of procedures.

Still, pursuing organs nationally is a worthwhile endeavour at their centre, the researchers said.

“They deliver very acceptable short-term outcomes,” Dr Renz said. “When you look at total costs, they are actually a very cost-effective and proven instrument for transplant centre growth. We think more studies like this are necessary at the centre level to actually see what the allocation units are. Because, likely, if you expand them, you’ll have a tremendous cost saving by giving sicker patients earlier access to organs.”