The efficiency and effectiveness of donor registry promotion and the organ donation process: impact on the availability and the cost of procuring organs for transplant

The remarkable progress of transplant medicine in the latter half of the twentieth century has led to an unprecedented demand for donated organs that have historically remained in short supply. Although a clinically effective procedure, organ transplant’s health benefit to the society is seriously limited by the shortage of organs. The resulting tragic and preventable loss of life is therefore a public health concern. This dissertation examines the efficiency and the effectiveness of the organ procurement process and its impact on the cost and availability of transplantable organs. Specifically, three issues are examined using data from western Pennsylvania and West Virginia, a region served by the Center for Organ Recovery and Education (CORE). \ud First, the effect of process breakdown on the availability of transplantable organs is examined using generalized linear model. The principal finding is that for every process breakdown in the care of a potential donor, one less organ is available for transplant. Consequently, 25 organs were lost to process breakdowns over the three-year study period.\ud Second, the cost of promoting the donor registry and its effect on the supply of organ donors is examined using decision analysis model. The principal finding is that CORE’s promotion efforts would generate 4.2 present-day donors at a cost of $726,000 per donor. When compared with previously published estimates of a donor’s monetary value to the society, CORE’s promotion efforts offer good return on investment.\ud Third, the impact of donor registry promotion on organ shortage is examined. Our analysis indicates that the impact threshold of registry promotion is reached at 64 donors that yield 73 kidneys, 45 livers, 18 lungs and 15 hearts. The principal finding is that registry promotion alone cannot arrest the growth in transplant waiting list. Although a cost-effective strategy, registry promotion has a significant budget impact.\ud Living donation and innovations that expand the donor pool or improve the organ acceptance rate may be able to arrest the growth in the waiting list. However, burden of waiting list deaths rests primarily on the causes of end-stage organ failure rather than organ shortage. Prevention and early intervention remain the first line of defense.\u