[Article written by and reprinted with permission of Emerging Therapy Solutions (ETS). ETS addresses the technological advancements in organ transport which may add anywhere from $17,000-$80,000 on top of transplant costs. This is fascinating technology because it allows for the organ to be viable for a longer period of time.]
Organ transplantation has been used successfully for decades, and the need for transplants continues to grow, driving an opportunity to leverage technology throughout the process. In the mid-2000s, there were over 25,000 organ transplants performed in the US each year. In 2023, that number reached over 46,000, and it continues to grow, based on Organ Procurement and Transplantation Network (OPTN) milestone data. Over that time and for over 50 years, the use of static cold storage, or placing an organ on ice, has been the standard in organ transplantation to preserve it during transport from the donor to the person needing a life-saving organ.
While a kidney may be viable for up to 36 hours on ice, a heart has only four hours before tissue damage (ischemia) occurs. This limits organ procurement and the geographic range over which organs can be allocated. Static cold storage can also cause tissue damage due to freezing and the inability to assess the organ’s function during transport, and tight time constraints can result in the loss of a potentially life-saving organ. Experts also know that the longer organs are without blood flow (ischemic), the greater the risk to the transplanted organ and patient's post-transplant survival.
Enter new technologies for organ transport such as Paragonix’s SherpaPak®, and organ perfusion systems like the TransMedic Organ Care system, that offer many advantages over traditional cold storage. The SherpaPak is a heart transport system that protects the donor heart in a sterile, pressure and temperature-controlled container and provides real-time organ monitoring for the clinical team. Data from the GUARDIAN-Heart Registry showed improved outcomes in organs preserved with the SherpaPak versus standard of care (cold storage), including increased post-transplant survival. Paragonix also has this technology for the lungs (LUNGguard™) and liver (LIVERguard™).
TransMedic Organ Care System (OCS) differs in that it maintains donor organs in a living, functioning state, providing a continuous supply of oxygenated, nutrient-rich blood in a portable container. This allows transplant surgeons to travel greater distances to the donor and extends the life of the organ, potentially expanding the donor pool. Medical teams can also assess the organ's health before transplantation, and surgical teams have more time in the operating room for complex cases. This technology has reported to improve transplant outcomes, including reducing graft (transplanted organ) dysfunction, and to potentially reduce the number of unused donor organs.
Cost for these organ transplant technologies varies greatly depending on the organ and the technology, and it clearly increases organ procurement costs. SherpaPak is estimated to cost between $9,000 to $17,000 per use, and the TransMedic OCS for the heart to cost $38,000 to $80,000 per single use. Despite this, some experts believe that the advantages organ transport systems offer in terms of shortening the wait list time and post-transplant hospital stays could potentially reduce the overall cost of care. A cost analysis, from the GUARDIAN registry study, reported an average savings of $20,000 per patient with the SherpaPak versus ice to preserve the heart during transport, though much more cost-effectiveness data is needed.
Many questions remain at the transplant system level, including who should pay for transport costs, and how to approach the cost-reimbursement structure for organ transport technologies that widen the geographic range from which organs are procured. Organ procurement organizations (OPOs) may opt to not cover costs for transportation services, supplies, and clinical resources for organs outside of their donor service area, meaning these organ acquisition fees may fall on the transplant hospital. Hospitals using transport technologies may push to modify their contract structures to account for the increase in organ acquisition costs, and payers may see high dollar claims for these services. However, utilization and evidenced-based positive patient outcomes for organ transport systems are being demonstrated, and the healthcare system has the opportunity to creatively collaborate to break down cost barriers and expand the possibilities for life-saving transplantation.
Sources:
https://optn.transplant.hrsa.gov/news/continued-increase-in-organ-donation-drives-new-records-in-2023-new-milestones-exceeded/
https://www.srtr.org/reports/optnsrtr-annual-data-report/ [
Heart transplant advances: Ex vivo organ-preservation systems - PMC (nih.gov)
Home - Transmedics [email.emergingtherapies.com]
Recipient Outcomes With Extended Criteria Donors Using Advanced Heart Preservation_ An Analysis of the GUARDIAN-Heart Registry (jhltonline.org)
‘Heart-in-a-Box’ Device Revolutionizes Organ Transport | Duke University School of Medicine
Organ perfusion systems a boon to heart and lung transplants - Mayo Clinic
Is the Organ Care System (OCS) Still the First Choice With Emerging New Strategies for Donation After Circulatory Death (DCD) in Heart Transplant? - PMC (nih.gov)
What are the barriers to wider use of organ perfusion? - UNOS
https://unos.org/news/insights/game-changers-at-the-forefront-of-organ-perfusion-technology/
https://unos.org/news/in-focus/lung-and-liver-perfusion-on-the-rise/