Gauthier Jason M, Doyle Maria B Majella, Chapman William C, Marklin Gary, Witt Chad A, Trulock Elbert P, Byers Derek E, Hachem Ramsey R, Pasque Michael K, Meyers Bryan F, Patterson G Alexander, Nava Ruben G, Kozower Benjamin D, Kreisel Daniel, Chang Su-Hsin, Puri Varun
Division of Cardiothoracic Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
J Thorac Dis. 2020 Oct;12(10):5709-5717. doi: 10.21037/jtd-20-1575.
Over the last decade two alternative models of donor care have emerged in the United States: the conventional model, whereby donors are managed at the hospital where brain death occurs, and the specialized donor care facility (SDCF), in which brain dead donors are transferred to a SDCF for medical optimization and organ procurement. Despite increasing use of the SDCF model, its cost-effectiveness in comparison to the conventional model remains unknown.
We performed an economic evaluation of the SDCF and conventional model of donor care from the perspective of U.S. transplant centers over a 2-year study period. In this analysis, we utilized nationwide data from the Scientific Registry of Transplant Recipients and controlled for donor characteristics and patterns of organ sharing across the nation's organ procurement organizations (OPOs). Subgroup analysis was performed to determine the impact of the SDCF model on thoracic organ transplants.
A total of 38,944 organ transplants were performed in the U.S. during the study period from 13,539 donors with an observed total organ cost of $1.36 billion. If every OPO assumed the cost and effectiveness of the SDCF model, a predicted 39,155 organ transplants (+211) would have been performed with a predicted total organ cost of $1.26 billion (-$100 million). Subgroup analysis of thoracic organs revealed that the SDCF model would lead to a predicted 156 additional transplants with a cost saving of $24.6 million.
The U.S. SDCF model may be a less costly and more effective means of multi-organ donor management, particularly for thoracic organ donors, compared to the conventional hospital-based model.
在过去十年中，美国出现了两种供体护理的替代模式：传统模式，即供体在脑死亡发生的医院进行管理；以及专门的供体护理机构（SDCF），脑死亡供体被转移到该机构进行医疗优化和器官获取。尽管SDCF模式的使用越来越多，但其与传统模式相比的成本效益仍然未知。
我们从美国移植中心的角度，在为期2年的研究期间对SDCF和传统供体护理模式进行了经济评估。在这项分析中，我们利用了来自移植受者科学登记处的全国性数据，并对供体特征和全国器官获取组织（OPO）之间的器官共享模式进行了控制。进行亚组分析以确定SDCF模式对胸器官移植的影响。
在研究期间，美国共进行了38944例器官移植，供体为13539例，观察到的器官总成本为13.6亿美元。如果每个OPO承担SDCF模式的成本和效益，预计将进行39155例器官移植（增加211例），预计器官总成本为12.6亿美元（减少1亿美元）。胸器官的亚组分析显示，SDCF模式预计将导致额外156例移植，节省成本2460万美元。
与传统的基于医院的模式相比，美国的SDCF模式可能是一种成本更低、更有效的多器官供体管理方式，特别是对于胸器官供体。
