Organ Specific Benefits of Transplantation: Outcomes and Economics

Organ transplantation has been established as the standard of care for advanced organ failure. Nevertheless, the availability of this complex clinical service is highly variable worldwide, and in general is limited to countries whose medical systems are technologically and economically developed. The challenges limiting the implementation of transplantation have to date been primarily focused on overcoming immunologic and technical barriers. However, with acceptable results now regularly attainable in a properly resourced setting, it is likely that the allocation and economic constraints on access to transplant care will assume a larger place in the field's literature. The primary goal of this chapter is to consider the organ specific implications of variation in donor quality, recipient severity of illness, and clinical practice patterns on the cost and benefit of organ transplant. This analysis will focus primarily on kidney, liver, and heart transplant procedures and relevant alternative treatments, as they are the most widely performed and the best studied. The intersection of organ allocation policy and transplant access with cost will also be examined as geographic differences between organ supply and recipient demand substantially influence transplant related resource utilization.