The rising cost of liver transplantation in the United States

被引:2
作者
Kaplan, Alyson [1 ]
Winters, Adam [2 ]
Klarman, Sharon [1 ]
Kriss, Michael [3 ]
Hughes, Dempsey [4 ]
Sharma, Pratima [5 ]
Asrani, Sumeet [6 ]
Hutchison, Alan [7 ]
Myoung, Paul [8 ]
Zaman, Asad [4 ]
Butler, Laura [9 ]
Pomposelli, James [10 ]
Gordon, Fredric [1 ]
Duarte-Rojo, Andres [4 ]
Devuni, Deepika [11 ]
Fortune, Brett [12 ]
机构
[1] Transplant Inst, Tufts Med Ctr, Dept Surg, 800 Washington St, Boston, MA 02111 USA
[2] Icahn Sch Med Mt Sinai, Recanati Miller Transplantat Inst, Div Liver Dis, New York, NY USA
[3] Univ Colorado, Sch Med, Dept Med, Div Gastroenterol & Hepatol, Aurora, CO USA
[4] Northwestern Univ, Dept Med, Div Gastroenterol & Hepatol, Chicago, IL USA
[5] Univ Michigan, Div Gastroenterol & Hepatol, Ann Arbor, MI USA
[6] Baylor Univ, Med Ctr, Hepatol, Dallas, TX USA
[7] Univ Chicago Med, Dept Med, Sect Gastroenterol Hepatol & Nutr, Chicago, IL USA
[8] Massachusetts Gen Hosp, Div Transplant Surg, Boston, MA USA
[9] Montefiore Med Ctr, Transplant Serv, Bronx, NY USA
[10] Univ Colorado, Dept Surg, Denver, CO USA
[11] UMass Chan Med Sch, Div Gastroenterol, Worcester, MA USA
[12] Montefiore Einstein Med, Div Hepatol, Bronx, NY USA
关键词
cost; deceased after cardiac death; liver transplantation; living donor liver transplantation; Organ Procurement and Transplantation Network; LIVING-DONOR; COMMERCIAL AIRLINES; ORGAN PROCUREMENT; CARDIAC DEATH; DONATION; FACILITY; IMPACT; MODEL;
D O I
10.1097/LVT.0000000000000493
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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 and utilization of donation after cardiac death 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, and the impact of new technologies. We also propose comprehensive solutions at national, organ procurement organization, 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.
引用
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页数:12
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