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Updated: May 5, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Financial impact of donation after circulatory death heart transplantation: A single-center analysis
Marian Urban1, Timothy R Ryan1, John Y Um1
1Department of Surgery, Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, USA.
Insights
Donation after circulatory death (DCD) heart transplantation shows no negative financial impact on hospital contribution margins compared to brain-dead donation (DBD). Evaluating institutional finances is crucial for DCD heart transplant programs.
Area of Science:
- Cardiology
- Transplantation Surgery
- Health Economics
Background:
- Donation after circulatory death (DCD) heart transplantation is increasingly adopted due to clinical success.
- DCD procurement requires additional resources compared to brain-dead donation (DBD).
- The hospital-level economic impact of DCD heart transplantation remains largely unknown.
Purpose of the Study:
- To compare the financial data of DCD versus DBD heart allografts.
- To evaluate the cost-effectiveness of different DCD organ recovery methods.
Main Methods:
- Retrospective financial analysis of 58 DBD and 22 DCD heart transplantations (Jan 2021-Dec 2022).
- Comparison of direct costs and contribution margins between DBD and DCD groups.
- Cost analysis of thoracoabdominal normothermic regional perfusion (TA-NRP) versus direct procurement with normothermic machine perfusion (DP-NMP) for DCD recovery.
Main Results:
- No significant difference in contribution margin per case between DBD ($234,362) and DCD ($235,440) heart transplantation.
- Direct costs were comparable: $171,949 for DBD and $186,250 for DCD.
- TA-NRP for DCD recovery ($155,955) was less costly than DP-NMP ($223,399), yielding a higher contribution margin for TA-NRP, though not statistically significant.
Conclusions:
- Adoption of DCD heart procurement did not negatively impact institutional contribution margins.
- Healthcare programs should assess their financial standing when implementing or performing DCD heart transplantation.
- TA-NRP may offer a more favorable economic profile for DCD heart recovery compared to DP-NMP.
Introduction:
Clinical success of donation after circulatory death (DCD) heart transplantation is leading to growing adoption of this technique. In comparison to procurement from a brain-dead donor, DCD requires additional resources. The economic impact of DCD heart transplantation from the hospital perspective is not well known.
Methods:
We compared the financial data of patients who received DCD allografts to those who received a DBD organ at our institution from January 1, 2021 to December 31, 2022. We also compared the cost of ex-situ machine perfusion to in-situ organ perfusion employed during DCD recovery.
Results:
We performed 58 DBD and 22 DCD heart-alone transplantations during the study period. Out of 22 DCD grafts, 16 were recovered with thoracoabdominal normothermic regional perfusion (TA-NRP) and six with direct procurement followed by normothermic machine perfusion (DP-NMP). The contribution margin per case for DBD versus DCD was $234,362 and $235,440 (P = .72). The direct costs did not significantly differ between the two groups ($171,949 and 186,250; P = .49). In comparing the two methods of procuring hearts from DCD donors, the direct cost of TA-NRP was $155,955 in comparison to $223,399 for DP-NMP (P = .21). This difference translated into a clinically meaningful but not statistically significant greater contribution margin for TA-NRP ($242, 657 vs. $175,768; P = .34).
Conclusions:
Our data showed that the adoption of DCD procurement did not have a negative financial impact on the contribution margin in our institution. Programs considering starting DCD heart transplantation, and those who are currently performing DCD procurement should evaluate their own financial situation.
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