From Clinical Benefit to Economic Value: A Scoping Review of Machine Perfusion in Solid-organ Transplantation

Despite growing awareness of organ donation, the persistent shortage of transplantable organs remains a challenge. Machine perfusion (MP) is a preservation technique that increases organ availability. As these technologies evolve, robust economic evaluations offer an opportunity to guide timely and consistent decision-making in transplantation. Therefore, the aim was to investigate existing economic evaluations of MP to determine to what extent they capture all relevant outcomes and mechanisms. Using JBI and PRISMA guidelines, a 3-step approach was used to identify (1) all MP-related outcomes reported in studies, (2) evaluate how these outcomes were incorporated into economic evaluations, and (3) examine the mechanisms used in economic models. Of 902 references, 43 studies were included. We found that (1) the beneficial outcomes of MP extended beyond complications, including reduced waitlist mortality, lower posttransplant costs, and improved logistics; (2) the incorporation of these outcomes varied within and among organ types, no study applied a societal perspective, and models differed in cycle length, time horizon, and health states; and (3) waitlist and complication effects were inconsistently modeled. More exhaustive and transparent use of mechanisms in economic evaluations in transplant care is needed to reach optimal decisions in policy, clinical practice, and research investments.