Liver Transplant Costs and Activity After United Network for Organ Sharing Allocation Policy Changes

Area of Science:

• Transplantation research
• Health policy analysis
• Organ allocation systems

Background:

• A new liver allocation policy was implemented by the United Network for Organ Sharing (UNOS) in February 2020.
• Concerns exist regarding the policy's impact on liver transplant (LT) access and costs.
• Previous analyses have not captured these implications at a multicenter level.

Purpose of the Study:

• To characterize changes in LT volume and associated costs across US transplant centers.
• To analyze these changes within specific center demographics post-policy implementation.
• To evaluate the financial and logistical impact of the new UNOS policy.

Main Methods:

• A cross-sectional study comparing two 12-month periods before and after the UNOS policy change (March 2019-March 2021).
• Analysis of LT volume and cost data from 22 participating US transplant centers.
• Comparison of outcomes based on center demographics and organ donation sources.

Main Results:

• A 6% decrease in overall LT volume was observed, with a 54% reduction in local donations and a 133% increase in imported donations.
• Overall hospital costs rose by 10.9%, with a 77% increase in fly-out costs.
• Centers serving minority populations and those in low-income states experienced disproportionately higher costs, particularly for imported organs.

Conclusions:

• Contrary to assumptions, the new liver allocation policy appears to increase costs and burden specific patient populations.
• The policy may exacerbate existing healthcare disparities for vulnerable groups awaiting liver transplants.
• Continuous allocation policies could worsen the current situation, necessitating policy review.