The use of normothermic regional perfusion (NRP) during organ retrieval offers several advantages including increasing the time available for a successful retrieval, improved quality and function of organs donated after circulatory death (DCD organs), and decreased risk of graft failure.
Based on data available from two UK transplant centres, NRP appears to dominate standard DCD retrieval. This means that NRP is less costly and more effective in terms of the number of surviving patients, than standard DCD retrieval. This is primarily because, compared to standard DCD, the additional equipment and staffing costs associated with NRP retrieval are recovered through lower rates of re-transplantation and fewer post-transplant complications.
The model estimated that for every 100 NRP retrievals, there would be four cases of death due to post-transplant complications, 69 cases of graft survival and 0.1 cases of death after re-transplantation at a total cost of approximately £2.38 million. In comparison, for every 100 standard DCD retrievals, there would be six cases of death due to post-transplant complications, 62 cases of graft survival and 0.67 cases of death after re-transplantation at a total cost of approximately £3.55 million.
The model was sensitive to small increases to the proportion of patients experiencing post-transplant complications, but was not sensitive to the additional costs of implementing NRP.
The key sources of uncertainty were the small sample sizes upon which the clinical evidence was based, limited data on the probability of death associated with many of the post-transplant complications and structural limitations of the model which necessitated simplifying assumptions.
What were we asked to look at?
We were asked to look at the cost effectiveness of employing normothermic regional perfusion (NRP) during liver graft retrieval in organ donors following circulatory death.
Why is this important?
The number of successful liver transplantations is limited by a shortage of viable donor organs. Waiting list pressure has led to the use of grafts at higher risk of failure. Livers donors after circulatory death (DCD) are one such high risk category and have been associated with poor transplant outcomes. Standard retrieval techniques can damage donor livers which could make them unsuitable for transplantation or increased complications post-transplantation. Our analysis assesses whether the incremental cost of using NRP to retrieve donor livers is economically justified in view of its potential to improve liver outcomes.
A consultant surgeon and a commissioning team from NHS Blood and Transplant (NHSBT)