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Updated: May 14, 2026

Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion

Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion

Published on: April 27, 2015

Is liver transplantation using organs donated after cardiac death cost-effective or does it decrease waitlist death

Leigh Anne Dageforde¹, Irene D Feurer, C Wright Pinson

¹Departments of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-4753, USA.

HPB : the Official Journal of the International Hepato Pancreato Biliary Association

|February 5, 2013

Summary

Utilizing organs donated after cardiac death (DCD) alongside organs donated after brain death (DBD) for liver transplantation (LT) is more cost-effective. This strategy improves quality-adjusted life years (QALYs) and reduces costs compared to using DBD organs alone.

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Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts

Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts

Published on: August 13, 2014

Area of Science:

Transplantation research
Health economics
Organ donation studies

Background:

Liver transplantation (LT) is a critical treatment for end-stage liver disease.
Organ scarcity necessitates exploring all available donor types, including those donated after cardiac death (DCD).
Comparing the cost-effectiveness of DCD versus brain death (DBD) donor organs is essential for optimizing LT resource allocation.

Purpose of the Study:

To evaluate the cost-effectiveness of using DCD organs in liver transplantation compared to using only DBD organs.
To analyze the impact of DCD organs on patient outcomes and healthcare costs in LT.

Main Methods:

A Markov-based decision analytic model was developed to simulate LT waitlist strategies.
The model compared outcomes over 10 years for strategies using (i) DBD organs only versus (ii) DBD and DCD organs.
Patient health states included survival, ischaemic cholangiopathy, retransplantation, and death, with sensitivity analyses performed.

Main Results:

The combined DBD + DCD organ strategy yielded 6.0 quality-adjusted life years (QALYs) at a cost of $61,000/QALY.
The DBD-only organ strategy yielded 5.6 QALYs at a cost of $69,000/QALY.
While DCD livers showed increased biliary complications and retransplantation, the overall strategy was superior.

Conclusions:

The use of DCD organs in liver transplantation significantly improves life extension and quality of life for patients on the waiting list.
The combined DBD + DCD organ strategy is more cost-effective than using DBD organs exclusively.
Continued utilization of DCD livers is recommended to enhance patient access to transplantation and improve overall outcomes.