Organ procurement expenditures and the role of financial incentives
R. W. Evans
Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905.
OBJECTIVES--To evaluate the billed charges for organ procurement and to
consider the role of financial incentives to encourage organ donation.
DESIGN--Observational study. Data were obtained on donor organ acquisition
charges from a random sample of kidney, heart, liver, heart-lung, and
pancreas transplants. SETTING--The data were based on 28.7% of all
transplants performed in the United States in 1988. MAIN OUTCOME
MEASURE--Total charges for donor organ acquisition. RESULTS--The median
charges (1988 dollars) for donor organs were as follows: kidney, $12,290;
heart, $12,578; liver, $16,281; heart-lung, $12,028; and pancreas, $15,400.
Since 1983, kidney acquisition charges have increased by 12.9%, heart
charges by 64.1%, and liver charges by 61.8%, after adjusting for
inflation. Between 9% and 31% of total transplant procedure-specific
charges were associated with donor organ acquisition. CONCLUSIONS--There is
wide unexplained variation in organ procurement charges. Data on actual
costs are required to establish the appropriateness of current charges.
Prevailing billing and payment methods should be reevaluated in an effort
to address a variety of issues related to reimbursement. Current payment
methods may actually contribute to cost inefficiency. Finally, while
financial incentives may enhance the efficiency of organ procurement
efforts, they will adversely affect the cost-effectiveness of
transplantation.
