Doyle Majella, Subramanian Vijay, Vachharajani Neeta, Collins Kelly, Wellen Jason R, Stahlschmidt Emily, Brockmeier Diane, Coleman Jason, Kappel Dean, Chapman William C
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
J Am Coll Surg. 2016 Apr;222(4):591-600. doi: 10.1016/j.jamcollsurg.2015.12.032. Epub 2016 Feb 29.
A new era in organ donation with national redistricting is being proposed. With these proposals, costs of organ acquisition are estimated to more than double. Traditionally, organ recoveries occur in the donor hospital setting, incurring premium hospital expenses. The aim of the study was to determine organ recovery costs and organ yield for donor recoveries performed at an organ procurement organization (OPO) facility.
In 2001, we established an OPO facility and in 2008 began transferring the donor expeditiously when brain death was declared. The OPO donor and hospital costs on a per donor basis were calculated. Donation after cardiac death donors cannot be transferred and were included in the hospital cost analysis.
From January 2009 to December 2014, nine hundred and sixty-three donors originating in our OPO had organs recovered and transplanted. Seven hundred and sixty-six (79.5%) donors were transferred to the OPO facility 8.6 hours (range 0.6 to 23.6 hours) after declaration of brain death. Donor recovery cost was 51% less when donors were transferred to the OPO facility ($16,153 OPO recovery vs $33,161 hospital recovery; p < 0.0001). Organ yield was 27.5% better (3.43 organs) from OPO-recovered donors vs an organ yield of 2.69 from hospital-recovered donors (p < 0.0001). Standard criteria donor organ yield from our OPO was 6% higher than the national average (3.92 vs 3.7 nationally; p = 0.012) and expanded criteria donor organ yield was 18% higher (2.2 vs 1.87 nationally; p = 0.03).
An OPO facility for donor organ recovery increases efficiency and organ yield, reduces costs, and minimizes organ acquisition charge. As we face new considerations with broader sharing, increased efficiencies, cost. and organ use should be considered.
有人提议开启器官捐献的新时代,进行全国性的重新分区。根据这些提议,器官获取成本预计将增加一倍多。传统上,器官获取在供体医院进行,会产生高昂的医院费用。本研究的目的是确定在器官获取组织(OPO)机构进行供体器官获取的成本和器官产出量。
2001年,我们设立了一个OPO机构,并于2008年在宣布脑死亡后开始迅速转运供体。计算了每个供体的OPO供体成本和医院成本。心脏死亡后捐献的供体无法转运,被纳入医院成本分析。
2009年1月至2014年12月,来自我们OPO的963名供体的器官被获取并移植。766名(79.5%)供体在宣布脑死亡后8.6小时(范围为0.6至23.6小时)被转运至OPO机构。当供体被转运至OPO机构时,供体获取成本降低了51%(OPO获取成本为16,153美元,医院获取成本为33,161美元;p < 0.0001)。OPO获取的供体器官产出量比医院获取的供体器官产出量高27.5%(分别为3.43个器官和2.69个器官;p < 0.0001)。我们OPO的标准标准供体器官产出量比全国平均水平高6%(分别为3.92个和全国平均的3.7个;p = 0.012),扩展标准供体器官产出量高18%(分别为2.2个和全国平均的1.87个;p = 0.03)。
用于供体器官获取的OPO机构提高了效率和器官产出量,降低了成本,并将器官获取费用降至最低。随着我们面临更广泛共享、更高效率、成本等新的考量因素,应考虑提高效率和器官利用率。