{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:50:28Z","timestamp":1790794228931,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Deceased donor organs for transplantation are costly. Expenses include donor assessment, pre\u2010operative care of acceptable donors, surgical organ recovery, preservation and transport, and other costs. US Organ Procurement Organizations (OPOs) serve defined geographic areas in which each OPO has exclusive organ recovery responsibilities including detailed reporting of costs. We sought to determine the costs of procuring deceased donor livers by examining reported organ acquisition costs from OPO cost reports. Using 6 years of US OPO cost report data for each OPO (2013\u20132018), we determined the average cost of recovering a viable (i.e., transplanted) liver for each of the 51 independent US OPOs. We examined predictors of these costs including the number of livers procured, the percent of nonviable livers, direct procurement costs, coordinator salaries, professional education, and local cost of living. A cost curve estimated the relationship between the cost of livers and the number of locally procured livers. The average cost of procured livers by individual OPO\u2010year varied widely from $11\u2009393 to $65\u2009556 (average $31\u2009659) over the six study years. An increase in the overall number of procured livers was associated with lower direct costs, administrative, and procurement overhead costs, but this association differed for imported livers. Cost per local liver decreased linearly for each additional liver, while importing more livers was only cost saving until 200 livers, with imported livers costing more ($39K vs. $31.7K). The largest predictor of variation in cost was the aggregate of direct costs (e.g., hospital costs) to recover the organ (57%). Cost increases were 2.5% per year (+$766\/year). This information may be valuable in determining how OPOs might improve service to transplant centers and the patients they serve.<\/jats:p>","DOI":"10.1111\/ctr.15452","type":"journal-article","created":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T04:00:25Z","timestamp":1725595225000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Cost of Procuring Deceased Donor Livers: Evidence From US Organ Procurement Organization Cost Reports, 2013\u20132018"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9069-9489","authenticated-orcid":false,"given":"Jennifer L.","family":"Bragg\u2010Gresham","sequence":"first","affiliation":[{"name":"Department of Internal Medicine \u2013 Nephrology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7494-1036","authenticated-orcid":false,"given":"Thomas G.","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Florida  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William P.","family":"Vaughan","sequence":"additional","affiliation":[{"name":"Transplant Solutions, LLC  Largo Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6436-3746","authenticated-orcid":false,"given":"Philip","family":"Held","sequence":"additional","affiliation":[{"name":"Division of Nephrology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6570-8961","authenticated-orcid":false,"given":"Frank","family":"McCormick","sequence":"additional","affiliation":[{"name":"Research Economist, Former Director of US Economic and Financial Research, Bank of America (retired)  Walnut Creek California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3303-9406","authenticated-orcid":false,"given":"John P.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Transplant Surgery University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,6]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Medicare Provider Reimbursement Manual Part 1 \u2013 Chapter 31 Organ Acquisition Payment Policy accessed August 16 2022 https:\/\/www.cms.gov\/Regulations\u2010and\u2010Guidance\/Guidance\/Transmittals\/downloads\/R471pr1.pdf."},{"key":"e_1_2_8_3_1","unstructured":"S.2048 \u2013 National Organ Transplant Act. 98th Congress (1983\u20101984) accessed June 30 2020 https:\/\/www.congress.gov\/bill\/98th\u2010congress\/senate\u2010bill\/2048."},{"key":"e_1_2_8_4_1","unstructured":"Department of Health and Human Services Centers for Medicare & Medicaid Services Medicare and Medicaid Programs Conditions for Coverage for Organ Procurement Organizations (OPOs) 42 CFR Parts 413 441 486 and 498 Federal Register\/Vol. 71 No. 104\/Wednesday May 31 2006\/Rules and Regulations accessed September 09 2024 https:\/\/www.cms.gov\/medicare\/health-safety-standards\/conditions-coverage-participation\/organ-procurement-organizations-opo"},{"key":"e_1_2_8_5_1","unstructured":"Department of Health and Human Services Centers for Medicare & Medicaid Services Chapter 33 Organ Procurement Organization and Tissue Typing Laboratory Cost Report Form CMS\u2010216\u201094; supporting statement for form CMS\u2010216\u201094 organ procurement organization\/histocompatibility laboratory cost report accessed September 09 2024 https:\/\/www.cms.gov\/regulations-and-guidance\/legislation\/paperworkreductionactof1995\/pra-listing-items\/cms-216-94."},{"key":"e_1_2_8_6_1","unstructured":"UNOS System Notice: Liver and Intestinal Organ Distribution Based on Acuity Circles Implemented Feb. 4 accessed June 28 2023 https:\/\/unos.org\/news\/system\u2010implementation\u2010notice\u2010liver\u2010and\u2010intestinal\u2010organ\u2010distribution\u2010based\u2010on\u2010acuity\u2010circles\u2010implemented\u2010feb\u20104\/."},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15669"},{"key":"e_1_2_8_8_1","unstructured":"Scientific Registry of Transplant Recipients Organ Procurement Organization Statistics accessed May 5 2023 https:\/\/www.srtr.org\/reports\/opo\u2010specific\u2010reports\/interactive\u2010report."},{"key":"e_1_2_8_9_1","unstructured":"Expatistan Cost of Living Index in North America accessed June 30 2020 https:\/\/www.expatistan.com\/cost\u2010of\u2010living\/index\/north\u2010america#price\u2010index\u2010explanation."},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15842"},{"key":"e_1_2_8_11_1","unstructured":"CMS Finalizes Policy That Will Increase the Number of Available Lifesavings Organs by Holding Organ Procurement Organizations Accountable through Transparency and Competition accessed May 28 2021 https:\/\/www.cms.gov\/newsroom\/press\u2010releases\/cms\u2010finalizes\u2010policy\u2010will\u2010increase\u2010number\u2010available\u2010lifesavings\u2010organs\u2010holding\u2010organ\u2010procurement."},{"key":"e_1_2_8_12_1","unstructured":"Medicare and Medicaid Programs; Organ Procurement Organizations Conditions for Coverage: Revisions to the Outcome Measure Requirements for Organ Procurement Organizations; Final rule accessed May 28 2021 https:\/\/www.cms.gov\/files\/document\/112020\u2010opo\u2010final\u2010rule\u2010cms\u20103380\u2010f.pdf."},{"key":"e_1_2_8_13_1","unstructured":"National Center for Health Statistics Mortality Data on CDC WONDER Raw Data Destroyed by Agreement on August 23 2021 Data access approval and download in November 2020 accessed August 23 2021 https:\/\/wonder.cdc.gov\/mcd.html."},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2023.01.010"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199210000-00001"},{"key":"e_1_2_8_16_1","unstructured":"N.Kurani M.Rae K.Pollitz K.Amin andC.Cox Price Transparency and Price Variation in U.S. Health Services accessed July 10 2023 https:\/\/www.kff.org\/health\u2010costs\/issue\u2010brief\/price\u2010transparency\u2010and\u2010price\u2010variation\u2010in\u2010u\u2010s\u2010health\u2010services\/."},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2017.04.016"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.tp.0000149787.97288.a2"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.tp.0000179637.37276.5a"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16978"},{"key":"e_1_2_8_21_1","unstructured":"2020\u20132023 Value Assessment Framework. Institute for Clinical and Economic Review accessed October 8 2022 https:\/\/icer.org\/wp\u2010content\/uploads\/2020\/10\/ICER_2020_2023_VAF_102220.pdf."},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2022.04.1732"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2021.4406"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16617"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.15452","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T10:26:39Z","timestamp":1727173599000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.15452"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":23,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1111\/ctr.15452"],"URL":"https:\/\/doi.org\/10.1111\/ctr.15452","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]},"assertion":[{"value":"2024-01-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e15452"}}