Department of Surgery, Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, USA.
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, USA.
Clin Transplant. 2024 Apr;38(4):e15296. doi: 10.1111/ctr.15296.
Clinical success of donation after circulatory death (DCD) heart transplantation is leading to growing adoption of this technique. In comparison to procurement from a brain-dead donor, DCD requires additional resources. The economic impact of DCD heart transplantation from the hospital perspective is not well known.
We compared the financial data of patients who received DCD allografts to those who received a DBD organ at our institution from January 1, 2021 to December 31, 2022. We also compared the cost of ex-situ machine perfusion to in-situ organ perfusion employed during DCD recovery.
We performed 58 DBD and 22 DCD heart-alone transplantations during the study period. Out of 22 DCD grafts, 16 were recovered with thoracoabdominal normothermic regional perfusion (TA-NRP) and six with direct procurement followed by normothermic machine perfusion (DP-NMP). The contribution margin per case for DBD versus DCD was $234,362 and $235,440 (P = .72). The direct costs did not significantly differ between the two groups ($171,949 and 186,250; P = .49). In comparing the two methods of procuring hearts from DCD donors, the direct cost of TA-NRP was $155,955 in comparison to $223,399 for DP-NMP (P = .21). This difference translated into a clinically meaningful but not statistically significant greater contribution margin for TA-NRP ($242, 657 vs. $175,768; P = .34).
Our data showed that the adoption of DCD procurement did not have a negative financial impact on the contribution margin in our institution. Programs considering starting DCD heart transplantation, and those who are currently performing DCD procurement should evaluate their own financial situation.
捐赠人循环死亡（DCD）供心移植的临床成功导致该技术的应用日益增多。与从脑死亡供者获取供心相比，DCD 需要额外的资源。从医院角度来看，DCD 供心移植的经济影响尚不清楚。
我们比较了 2021 年 1 月 1 日至 2022 年 12 月 31 日期间在我院接受 DCD 同种异体移植物的患者与接受 DBD 器官的患者的财务数据。我们还比较了 DCD 恢复过程中使用的离体机器灌注与原位器官灌注的成本。
在研究期间，我们进行了 58 例 DBD 和 22 例 DCD 单纯心脏移植。22 例 DCD 移植物中，16 例采用胸腹腔常温区域灌注（TA-NRP）恢复，6 例直接采集后采用常温机器灌注（DP-NMP）恢复。DBD 与 DCD 的每例病例贡献边际分别为$234,362 和$235,440（P=0.72）。两组的直接成本无显著差异（$171,949 和$186,250；P=0.49）。在比较从 DCD 供者获取心脏的两种方法时，TA-NRP 的直接成本为$155,955，而 DP-NMP 为$223,399（P=0.21）。这一差异转化为 TA-NRP 更高的临床意义但无统计学意义的贡献边际（$242,657 比$175,768；P=0.34）。
我们的数据表明，在我院，采用 DCD 供者获取方法对贡献边际没有负面的财务影响。考虑开展 DCD 供心移植的项目和目前正在开展 DCD 供者获取的项目，应评估其自身的财务状况。
