Among OPOs, wide variations in kidney procurement costs

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The average cost of procuring a deceased-donor kidney is $36,000, but the cost varies substantially between different organ procurement organizations (OPOs), concludes a study in the American Journal of Transplantation.

The researchers analyzed annual cost reports from 51 of 58 OPOs in the United States from 2013 to 2017. Data analysis focused on variations in kidney procurement costs, including differences in costs by OPO size, based on annual number of kidneys procured. The analysis also considered costs associated with acquisition of viable (transplanted) versus nonviable (discarded) kidneys and other OPO outcomes.

Over the 5-year period studied, the average cost per transplanted kidney was $36,000 (range, ∼$24,000 to $56,000). The average number of kidneys transplanted was 274 per OPO, and the average nonviable kidney rate was 18.4%. The number of nonviable kidneys was positively associated with the number of viable kidneys procured: for every 10 viable kidneys, 2.4 nonviable kidneys would be expected.

The costs per viable kidney were higher for OPOs that procured higher numbers of nonviable kidneys: for a 1% increase in nonviable kidneys, the cost per viable kidney increased by $275. Across OPOs, the cost per viable kidney tended to decrease up to 549 kidneys per year but then increased thereafter. The costs of kidney procurement were also related to local cost levels, donation after cardiac death, year, and standardized donor rate ratio. During the period studied, costs increased by 3% per year.

Although previous studies have examined the costs of the organ transplantation process, less is known about the costs of organ acquisition. The new study documents a significant variation in kidney procurement costs among OPOs.

Procurement costs are affected by the percentage of viable versus nonviable kidneys, OPO size, and a range of other factors. The researchers discuss the implications for addressing possible inefficiencies in the current OPO structure [Held PJ, et al. The cost of procuring deceased donor kidneys: Evidence from OPO cost reports 2013–2017. Am J Transplant 2020; 20:1087–1094].