Lehr Carli J, Skeans Melissa A, Lease Erika D, Valapour Maryam
Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.
Am J Transplant. 2021 Dec;21(12):4012-4022. doi: 10.1111/ajt.16697. Epub 2021 Jun 28.
On November 24, 2017, US lung transplant policy replaced donor service area with 250-nautical-mile radius as the first unit of allocation. Understanding this policy's economic impact is important, because the United States is poised to adopt the broadest feasible geographic organ distribution. All lung transplant recipients from January 1, 2015, to December 31, 2018, in the Scientific Registry of Transplant Recipients, were included. Recipients before and after November 24, 2017 were in the donor service area-first and 250-nautical-mile donor service area-free periods, respectively. Travel time was estimated using a Google application; mode was assigned as flying when driving time was longer than 60 min. Travel costs were estimated by mode and distance. Travel distance and time for organ procurement increased under the policy change. The estimated proportion of organs traveling by air increased from 61% to 76%. Estimated average costs increased by $14 051 if travel mode changed to flying, resulting in an average increase of $1264 for all transplants. Travel costs were highest for candidates <18 years and adults with high lung allocation scores. Broader geographic distribution increased estimated organ procurement costs for a small percentage of lung transplants. Further analysis should elucidate the broad economic impact of such policies.
2017年11月24日，美国肺移植政策将半径250海里的供体服务区作为首个分配单位，取代了原有的供体服务区。了解该政策的经济影响十分重要，因为美国正准备采用最广泛可行的地理器官分配方式。纳入了移植受者科学登记处2015年1月1日至2018年12月31日期间的所有肺移植受者。2017年11月24日之前和之后的受者分别处于供体服务区优先期和无250海里供体服务区期。使用谷歌应用程序估算旅行时间；当驾车时间超过60分钟时，出行方式指定为飞行。根据出行方式和距离估算旅行费用。政策变更后，器官获取的旅行距离和时间增加。通过航空运输的器官估计比例从61%增至76%。如果出行方式改为飞行，估计平均费用增加14,051美元，所有移植的平均费用增加1264美元。对于年龄小于18岁的候选者和肺分配评分高的成年人，旅行费用最高。更广泛的地理分布增加了一小部分肺移植的估计器官获取成本。进一步分析应阐明此类政策的广泛经济影响。
