*Purpose: The cost of procuring deceased donor organ for transplantation include costs for the assessment of potential organ donors, maintenance of the donor while waiting organ recovery, the surgical recovery of the viable organs and the cost of transportation. Organ Procurement Organizations (OPOs) have defined geographic service area for which they have exclusive responsibility for organ recovery. By examining the variations in reported organ acquisition charges from the CMS OPO Cost Reports, we may aim to elucidate policy issues affecting the OPOs.

*Methods: Using six years of US OPO data (2013-2018), we determined the cost of recovering a viable (i.e., transplanted) liver for each of the 51 independent OPOs. We examined predictors of these costs, which included number livers procured, percent nonviable livers, direct costs of procurement, professional education, procurement coordinators salaries, and local cost of living. A quadratic liver cost curve estimated the relationship between the cost of livers and the number of viable livers recovered.

*Results: During the study period, 50,991 livers were recovered (44,513 viable and 6,373 nonviable). The cost of transplanted livers at individual OPOs varied widely from $19,285 to $63,444 over the six years with an average cost of $37,166. The cost of a viable liver tended to decline with the number of livers procured up to 350 livers per year and then increased slightly. Cost increases were 3% per year (+$932/year).

*Conclusions: The cost function demonstrates that the number of livers recovered by the OPO is associated with the cost per viable liver, suggesting there may be an optimal number of livers recovered for an OPO.

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