ORGAN PROCUREMENT EXPENDITURES AND THE ROLE OF FINANCIAL INCENTIVES

Objectives.-To evaluate the billed charges for organ procurement and to consider the role of financial incentives to encourage organ donation. Design.-Observational study. Data were obtained on donor organ acquisition charges from a random sample of kidney, heart, liver, heart-lung, and pancreas transplants. Setting.-The data were based on 28.7% of all transplants performed in the United States in 1988. Main Outcome Measure.-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.