Financial impact of donation after circulatory death heart transplantation: A single‐center analysis

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Abstract
Introduction: 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.Methods: 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.Results: 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).Conclusions: 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.

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