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Salvaging Discarded Livers with Normothermic Machine Perfusion: Is it Worth the Cost?

R. J. de Vries, S. Raigani, C. Carroll, Y. Chen, D. C. Chang, J. F. Markmann, K. Uygun, H. Yeh

Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA

Meeting: 2020 American Transplant Congress

Abstract number: 163

Keywords: Economics, Liver transplantation, Machine preservation

Session Information

Session Name: All Organs: Economics & Ethics

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

 Presentation Time: 4:15pm-4:27pm

Location: Virtual

*Purpose: Normothermic machine perfusion (NMP) enables transplantation of discarded grafts with excellent outcomes in clinical trials. The cost of deploying NMP is often cited as the biggest barrier to widespread implementation, especially since large clinical studies do not show clear clinical improvements or overall cost savings for standard criteria donor livers graft. However, the cost-benefit analysis of NMP for salvage of discarded grafts for transplantation has yet to be evaluated.

*Methods: We tested 20 discarded donor livers for viability with NMP to predict the potential salvage rate in a United States sample cohort. The minimum, median and maximum perfusion costs per graft in a back-to-base setting were subsequently calculated, accounting for the price range of perfusion systems, materials and reagents, personnel and facility costs, and for different operative and perfusion durations. Next, we modeled the costs to convert one discarded liver for transplantation as a function of these perfusion costs, and the percentage of livers that met transplantable viability criteria during NMP.

*Results: 55% of the tested discarded livers met the transplantable viability criteria used in clinical trials. The median NMP cost per graft was $15,406, of which 91% were fixed and 9% variable with perfusion duration. Imputing these parameters in our model, the median costs to yield one discarded liver for transplantation with NMP was $28,011. Including additional procurement costs to recover grafts that are currently not recovered for transplant raised these costs to $44,869.

*Conclusions: The median costs to convert one discarded graft for transplantation with NMP are low in perspective to the average $577,100 USD cost of a liver transplant and the monthly $22,675 cost of care for a high MELD-score waitlist patient. Therefore, the costs of NMP should not limit its clinical implementation in efforts to alleviate the donor organ shortage.

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To cite this abstract in AMA style:

Vries RJde, Raigani S, Carroll C, Chen Y, Chang DC, Markmann JF, Uygun K, Yeh H. Salvaging Discarded Livers with Normothermic Machine Perfusion: Is it Worth the Cost? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/salvaging-discarded-livers-with-normothermic-machine-perfusion-is-it-worth-the-cost/. Accessed May 11, 2025.

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