Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California.
Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.
Am J Transplant. 2021 Nov;21(11):3694-3703. doi: 10.1111/ajt.16617. Epub 2021 May 8.
A potential solution to the deceased donor organ shortage is to expand donor acceptability criteria. The procurement cost implications of using nonstandard donors is unknown. Using 5 years of US organ procurement organization (OPO) data, we built a cost function model to make cost projections: the total cost was the dependent variable; production outputs, including the number of donors and organs procured, were the independent variables. In the model, procuring one kidney or procuring both kidneys from double/en bloc transplantation from a single-organ donor resulted in a marginal cost of $55 k (95% confidence interval [CI] $28 k, $99 k) per kidney, and procuring only the liver from a single-organ donor results in a marginal cost of $41 k (95% CI $12 k, $69 k) per liver. Procuring two kidneys for two candidates from a donor lowered the marginal cost to $36 k (95% CI $22 k, $66 k) per kidney, and procuring two kidneys and a liver lowers the marginal cost to $24 k (95% CI $17 k, $45 k) per organ. Economies of scale were observed, where high OPO volume was correlated with lower costs. Despite higher cost per organ than for standard donors, kidney transplantation from nonstandard donors remained cost-effective based on contemporary US data.
扩大供体接受标准可能是解决已故供体器官短缺的一个办法。使用非标准供体的采购成本影响尚不清楚。利用美国器官获取组织（OPO）5 年的数据，我们构建了一个成本函数模型来进行成本预测：总成本是因变量；包括供体数量和器官采集数量在内的生产产出是自变量。在该模型中，从单个供体的双器官/整块移植中获取一个肾脏或两个肾脏的边际成本为每肾 55000 美元（95%置信区间：28000 美元，99000 美元），从单个供体仅获取肝脏的边际成本为每肝 41000 美元（95%置信区间：12000 美元，69000 美元）。从供体为两名受者获取两个肾脏，将每肾的边际成本降低至 36000 美元（95%置信区间：22000 美元，66000 美元），获取两个肾脏和一个肝脏将使每器官的边际成本降低至 24000 美元（95%置信区间：17000 美元，45000 美元）。观察到规模经济，即高 OPO 量与低成本相关。尽管非标准供体的器官每例成本高于标准供体，但根据当代美国数据，非标准供体的肾脏移植仍然具有成本效益。
