Costs related to obtaining organs for transplantation: A systematic review

Cost analysis of corneal tissue processing: A scoping review protocol

INTRODUCTION

Diseases affecting the cornea are a group of pathological conditions responsible for the main causes of blindness worldwide. Corneal transplantation aims to replace dysfunctional corneal tissue with a transparent tissue graft obtained from a deceased donor, which enables the full recovery of lost vision. Processes are initially performed to prepare the corneal tissue for transplantation in order for this transplant to be viable. There is a gap in knowledge regarding the costs of these processes. This review aims to carry out a robust, broad and current mapping of studies which analyze the costs of processing corneal tissue for transplantation.

OBJECTIVE

The objective of this study is to map the evidence produced in the literature on cost analysis studies of corneal tissue processing.

MATERIALS AND METHODS

A scoping review will be conducted to map the topic, gather different research designs and identify the available scientific evidence on corneal tissue processing. To this end, a scoping review protocol was developed, registered in the Open Science Framework (accessed at: DOI 10.17605/OSF.IO/2X89U), following the good practices described by the Joanna Briggs Institute. The review report will be guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. The data will be presented descriptively, with a summary of the studies found. The guiding research question of the study is: What is the scope of scientific evidence on the cost analysis of corneal tissue processing for transplants?

Association of procurement technique with organ yield and cost following donation after circulatory death

Donation after circulatory death (DCD) could account for the largest expansion of the donor allograft pool in the contemporary era. However, the organ yield and associated costs of normothermic regional perfusion (NRP) compared to super-rapid recovery (SRR) with ex-situ normothermic machine perfusion, remain unreported. The Organ Procurement and Transplantation Network (December 2019 to June 2023) was analyzed to determine the number of organs recovered per donor. A cost analysis was performed based on our institution's experience since 2022. Of 43 502 donors, 30 646 (70%) were donors after brain death (DBD), 12 536 (29%) DCD-SRR and 320 (0.7%) DCD-NRP. The mean number of organs recovered was 3.70 for DBD, 3.71 for DCD-NRP (P < .001), and 2.45 for DCD-SRR (P < .001). Following risk adjustment, DCD-NRP (adjusted odds ratio 1.34, confidence interval 1.04-1.75) and DCD-SRR (adjusted odds ratio 2.11, confidence interval 2.01-2.21; reference: DBD) remained associated with greater odds of allograft nonuse. Including incomplete and completed procurement runs, the total average cost of DCD-NRP was $9463.22 per donor. By conservative estimates, we found that approximately 31 donor allografts could be procured using DCD-NRP for the cost equivalent of 1 allograft procured via DCD-SRR with ex-situ normothermic machine perfusion. In conclusion, DCD-SRR procurements were associated with the lowest organ yield compared to other procurement methods. To facilitate broader adoption of DCD procurement, a comprehensive understanding of the trade-offs inherent in each technique is imperative.

Transplant management in Brazil: a temporal analysis of financial investments and procedures

OBJECTIVE

To analyze public management actions regarding organ, cell, and tissue transplant procedures and their financial investments in Brazil.

METHOD

Mixed (time and place) ecological study, carried out based on data from the Hospital Information System of the Brazilian Public Health System (SUS) Information Technology Department and the National Transplant System, from 2001 to 2023. Temporal trend analyses, descriptive and inferential statistics were performed.

RESULTS

Organ, cell, and tissue transplants are concentrated in the Southeast region of the country, with increased costs there. The Northeast and South regions of Brazil have the longest waiting list, with an increasing trend (R2 = 0.96), associated with a decreasing trend in the number of transplants (R2 = 0.97).

CONCLUSION

The difference in the total number of transplants and procedures performed among the Brazilian regions represents the need for organization and investments with strategies aimed at training professionals and raising awareness among the population.