The Cost Effectiveness of Deceased Organ Donation

Recently, Medeloff et al. (1) estimated the cost-effectiveness of deceased organ donation, indicating a modest increase in health care costs of $16,000 for each quality adjusted life year saved by the average donor. However, the au-thors admit that there is "considerable uncertainty" about their estimate. They call for "further analysis of some of the available large databases … to provide more reliable estimates." Analyses of these "large databases" have been performed for kidney transplantation from a deceased donor by numerous investigators (2–5). These studies have documented the actual outcomes and cost of care for waitlisted patients and recipients of kidney transplants. Thus, the actual cost savings provided by kidney transplantation is well known. All of these estimates indicate the cost savings of kidney transplantation far exceed the central estimate presented by Mendeloff et al., a savings of $1,978 per kidney transplant, ranging much closer to their best case estimate, a savings of $132,053 (1). Correcting this pessimistic estimate and accounting for the frequency of government payment for transplantation suggest there is good reason to believe that increasing donation will decrease total government expenses with important policy implications as follows. Averaged across all deceased donors, federal, or state agencies in the United States pay for the care of approximately 1.03 kidney, 0.25 liver, and 0.37 heart transplant recipients (REF UNOS). Thus, kidney transplant is by far the most important for government costs. As indicated, the highest quality estimates of the economic impact of kidney transplantation resemble the best case estimates of Mendeloff et al. (1). Adjusting our most recent estimates to account for postkidney transplant Medicare limitations and a mix of 80% standard and 20% expanded criteria donors produces an average cost savings estimate of $141,857 to Medicare per covered kidney transplant (5). Using Dr. Mende-loff's smaller $132,053 "best case" savings estimate for kidney, with the central estimates for liver (a cost of $200,384) and heart (a cost of $174,699), although we suspect these are excessive, yields a cost savings of $61,537 per deceased donor to government agencies. Initial figures indicate approximately 500 (8%) more deceased donors were recovered in 2004 than 2003. Therefore we expect cost savings to the government in excess of $30 million from the additional transplants in 2004 alone. The $25 million authorized in the Organ Donor Recovery and Improvement Act signed into law in 2004 has yet to receive an appropriation. How many more donors could be recovered and how much money could the government save with more extensive investment in organ donation? The answers are open to speculation. However, we expect both are substantial. We applaud and appreciate the efforts of Dr. Mendeloff and colleagues. However, it is the estimate provided here that we need to bring to the US legislature so that it is understood that increased organ donation should decrease government expenditures. Mark A. Schnitzler Krista L. Lentine Thomas E. Burroughs Saint Louis University School of Medicine Center for Outcomes Research Salus Center St. Louis, MO