Organ procurement expenditures and the role of financial incentives.
OBJECTIVE
To evaluate the billed charges for organ procurement and to consider the role of financial incentives to encourage organ donation.


METHODS
Observational study. Data were obtained on donor organ acquisition charges from a random sample of kidney, heart, liver, heart-lung, and pancreas transplants.


METHODS
The data were based on 28.7% of all transplants performed in the United States in 1988.


METHODS
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.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905.
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Evans
D000533:Altruism; D003365:Costs and Cost Analysis; D035082:Federal Government; D005249:Fees and Charges / Q000706:statistics & numerical data; D016027:Heart Transplantation / Q000191:economics; D016041:Heart-Lung Transplantation / Q000191:economics; D018594:Human Body; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics; D016031:Liver Transplantation / Q000191:economics; D006278:Medicare / Q000706:statistics & numerical data; D016035:Pancreas Transplantation / Q000191:economics; D012052:Reimbursement, Incentive; D040841:Resource Allocation; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000191:economics* / Q000458:organization & administration; D014481:United States