*Purpose: Existing literature shows intra-operative cooling of a renal allograft during anastomosis reduces the incidence of delayed graft function in deceased donor kidney transplant recipients from a baseline rate of 35% to 25%, 5-year graft loss from 23% to 16%, and increases the number of transplantable kidneys from 18,686 to 19,479. Cost effectiveness of an organ cooling device was evaluated with a Markov Model.

*Methods: A state-transition model was used to predict the effect of intra-operative cooling and standard of care on 1-year and lifetime probabilities of having a functioning graft, delayed graft function, graft loss with return to dialysis, and death. We adopted a societal perspective and estimated an incremental-cost-effectiveness ratio in U.S. dollars per quality adjusted life year (QALY).

*Results: Intra-operative allograft cooling of deceased donor kidneys provides a 0.01 QALY improvement and $4,800 in savings per patient at 1-year, and over a lifetime, provides 0.26 QALYs and $12,200 in savings per patient. In both the 1-year and lifetime estimates, the ICER is dominant with the cooling device. The total cost savings, not including QALY gains to the system in this group, is $228 million. Including cost savings of the projected increase in organ utilization resulted in $1.18 billion in savings over the lifetime of an annual cohort of transplant recipients. The 95% credible interval for ICER was cost-saving to $39,000 per quality adjusted life year.

*Conclusions: The model suggests that intra-operative cooling of a deceased donor renal allograft with the device, over a wide range of assumptions, is a cost effective strategy for transplantation that might result in significant cost savings and lower morbidity and mortality.

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