Research Mentor Name

Charles S Day

Research Mentor Email Address

cday9@hfhs.org

Institution / Department

Henry Ford Health

Document Type

Research Abstract

Research Type

businessinmedicine

Graduate Level Research

no

Abstract

Background: As liver transplantation expands to include marginal donor organs, technologies such as the TransMedics Organ Care System (OCS) offer the potential to improve graft viability and clinical outcomes. However, limited institution-level evidence exists evaluating the cost-outcomes balance of OCS use in Donation-After-Circulatory-Death (DCD) liver transplantation. This study assesses the clinical, operational, and economic value of OCS implementation within a high-volume transplant center.

Methods: A retrospective cohort analysis was conducted of all DCD liver transplants performed at Henry Ford Hospital from January 2021 to April 2024. Outcomes were compared between traditional cold storage (2021; n=23) and OCS perfusion (2023–2024; n=82). Clinical data were obtained from the electronic health record, and cost/margin data were derived from internal institutional accounting. Primary outcomes included biliary complications, re-transplantation, 90-day and 1-year mortality, transplant volume, total episode-of-care cost, and net margin. Descriptive and comparative analyses were performed.

Results: OCS implementation was associated with substantial clinical improvement. One-year mortality decreased from 9% (2021) to 0% (2024), and 90-day mortality decreased to 0%. Overall complication rates declined from 52% to 36%, including a 39.6% reduction in biliary complications. Operationally, annual transplant volume increased by 82.6%—from 23 cases in 2021 to 42 in 2024—reflecting expanded donor utilization and improved logistical efficiency. Financially, net revenue nearly doubled from $5.68M to $10.97M. However, total direct costs increased by 211.1%, primarily due to device-related expenses totaling $4.97M. Despite reduced complications and readmissions, current OCS pricing resulted in a negative per-case margin.

Conclusion: TransMedics OCS adoption in DCD liver transplantation was associated with improved clinical outcomes, reduced postoperative complications, and significant growth in transplant capacity. However, the current cost structure renders OCS economically unsustainable despite its clinical and operational benefits. Future work should focus on defining break-even device pricing, optimizing institutional resource utilization, and partnering with payers to align reimbursement with demonstrated clinical value.

Disciplines

Hepatology | Medicine and Health Sciences | Quality Improvement | Surgery | Surgical Procedures, Operative

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