*Purpose: Economic theory suggests that there should be an initial decrease in costs of products as production levels increase. Using data from independent OPOs we test this theory and assess for decreases in costs of deceased donor kidney recovery for transplant by size of the OPO.

*Methods: Cost reports (CMS 216-94 Form) from 52 Independent OPOs (a practical census) for 5-years were assessed to determine the average cost per kidney recovered for transplant for each OPO. The number of kidneys recovered in a given year were used as a measure of the OPOs size. A cubic regression model was employed to assess the association between average cost per kidney recovered (y) with a proxy for the size of the OPO (x) as measured by number of kidneys recovered. An adjustment for the local cost of living was included.

*Results: The model estimates are presented in the table below and the cost curve is displayed graphically. The cost curve suggests an initial reduction is cost per kidney with each additional kidney recovered up to a count of ~380 kidneys. We then see a slight upturn in estimated costs, which is largely driven by two large, high cost OPOs

*Conclusions: The OPO cost reports demonstrate that the number of kidneys recovered by the OPO is associated with the cost per kidney. This may be related to a certain amount of fixed costs unrelated to volume that can be spread over more kidneys decreasing the cost per kidney. These data suggest that there may be an optimal number of kidneys recoveries for an OPO.

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