TY - JOUR
T1 - The rising cost of liver transplantation in the United States
AU - Kaplan, Alyson
AU - Winters, Adam
AU - Klarman, Sharon
AU - Kriss, Michael
AU - Hughes, Dempsey
AU - Sharma, Pratima
AU - Asrani, Sumeet
AU - Hutchison, Alan
AU - Myoung, Paul
AU - Zaman, Asad
AU - Butler, Laura
AU - Pomposelli, James
AU - Gordon, Fredric
AU - Duarte-Rojo, Andres
AU - Devuni, Deepika
AU - Fortune, Brett
N1 - Publisher Copyright:
Copyright © 2024 American Association for the Study of Liver Diseases.
PY - 2024
Y1 - 2024
N2 - Liver transplantation (LT) is the only curative treatment for end-stage liver disease and significantly improves patient outcomes. However, LT is resource-intensive and costly, with expenditures rising dramatically in recent years. Factors contributing to this increase in cost include expanded transplant criteria, utilization of marginal organs, and broader organ distribution, resulting in significant logistical expenses. Advanced technologies like organ perfusion devices, while promising better outcomes, further inflate costs due to their high price and market monopolization. Moreover, living donor liver transplant (LDLT) and utilization of donation after cardiac death (DCD) organs introduce higher initial expenditures yet potential long-term savings. Despite rising costs, reimbursement has remained largely stagnant, putting financial strain on transplant programs, and threatening their sustainability. This review examines the multifaceted drivers of rising costs in LT, focusing on recent policy changes, the role of organ procurement organizations (OPOs) and the impact of new technologies. We also propose comprehensive solutions at national, OPO, and local levels, including optimizing resource allocation, leveraging regional collaborations, and advocating for revised reimbursement models to curb escalating costs. Addressing these challenges is critical to ensuring the continued viability of LT programs and maintaining patient access to this life-saving intervention.
AB - Liver transplantation (LT) is the only curative treatment for end-stage liver disease and significantly improves patient outcomes. However, LT is resource-intensive and costly, with expenditures rising dramatically in recent years. Factors contributing to this increase in cost include expanded transplant criteria, utilization of marginal organs, and broader organ distribution, resulting in significant logistical expenses. Advanced technologies like organ perfusion devices, while promising better outcomes, further inflate costs due to their high price and market monopolization. Moreover, living donor liver transplant (LDLT) and utilization of donation after cardiac death (DCD) organs introduce higher initial expenditures yet potential long-term savings. Despite rising costs, reimbursement has remained largely stagnant, putting financial strain on transplant programs, and threatening their sustainability. This review examines the multifaceted drivers of rising costs in LT, focusing on recent policy changes, the role of organ procurement organizations (OPOs) and the impact of new technologies. We also propose comprehensive solutions at national, OPO, and local levels, including optimizing resource allocation, leveraging regional collaborations, and advocating for revised reimbursement models to curb escalating costs. Addressing these challenges is critical to ensuring the continued viability of LT programs and maintaining patient access to this life-saving intervention.
KW - cost
KW - deceased after cardiac death
KW - liver transplantation
KW - living donor liver transplantation
KW - organ procurement and transplantation network
UR - http://www.scopus.com/inward/record.url?scp=85205288940&partnerID=8YFLogxK
U2 - 10.1097/LVT.0000000000000493
DO - 10.1097/LVT.0000000000000493
M3 - Article
C2 - 39315930
AN - SCOPUS:85205288940
SN - 1527-6465
JO - Liver Transplantation
JF - Liver Transplantation
M1 - LVT.0000000000000493
ER -