Procuring organ donors as a health investment: how much should we be willing to spend?

BACKGROUND This paper examines the benefits and costs that accrue when a cadaveric organ donor is procured. We estimate the cost per quality-adjusted life year (QALY) for donor procurement. Our objective was not only to see whether organ procurement is a "good" health investment, but also to clarify how much it is worth spending to obtain additional donors. METHODS We calculated the average number of kidney, heart, and liver transplants that a typical cadaveric donor generates. Relying primarily on reviewing the published literature, we estimated for each organ type the average number of QALYs that transplants add and the average medical costs they generate. We multiplied per organ benefits and costs by the number of organs from the typical donor, and summed the results to calculate the cost per QALY from procuring an additional donor. We conducted extensive sensitivity analyses of the assumptions. RESULTS Our central estimate indicates that the typical donor generates about 13 QALYs at an added medical cost of about $214,000, a cost of approximately $16,000 per QALY. Our high estimate is approximately $57,000. CONCLUSIONS The implications of these findings depend upon how we choose to value QALYs. Most analysts agree that a figure of $100,000 is reasonable. At this value, the benefit obtained from one added donor would be $1.3 million (13 x $100,000) while the medical costs would be $214,000. The implication is that we should be willing to spend up to $1,086,000 ($1.3 million - $214,000) to obtain one more donor.