From tackling logistical concerns to overcoming financial burdens, the inner workings of transplantation require thoughtful management and insight.
Sharon Klarman, BSN, RN, executive director of solid organ transplant at Burlington, Mass.-based Tufts Medicine, spoke with Becker’s about rising organ acquisition costs and the issues hospital and health system leaders should consider when developing transplant programs.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Could you provide a bit of background on the recent increase in organ acquisition costs for solid organ transplants?
Sharon Klarman: The rising cost of organ acquisition is one of the most pressing financial challenges facing the field of transplant today. It is driven by a combination of national policy changes, new technological advancements and increasing logistical complexity in terms of acquiring organs.
One of the most significant contributors has been the national shift to broader geographic sharing policies of organs. This shift has transformed the way organs are allocated and has been instrumental in improving equity and access. The intent of the policy changes was focused on making sure that patients are receiving organ offers despite geographic barriers, but they’ve also really increased the logistical burden and cost for transplant centers.
Organs are traveling much farther than before. Our team at Tufts is traveling up to 3,000 nautical miles to acquire hearts from the other side of the country. This really leads to significantly higher aviation costs, more frequent reliance on preservation and perfusion techniques and devices, and greater operational demands on both transplant centers and organ procurement organizations.
Ultimately, our field has made really remarkable strides in increasing transplant access, but now we need to address the economic realities that come with these advancements.
Q: How has the rise in organ acquisition costs affected U.S. transplant programs in general?
SK: Transplant programs across the country are navigating significant financial pressures due to these rising costs.
While organ acquisition is cost-reimbursable under Medicare, the lag in reimbursement often creates a financial strain, especially for programs operating in high-cost regions.
Additionally, increased acquisition costs place pressure on hospitals to absorb greater financial risk, particularly in transplant where we’re combining organ acquisition expenses with other inpatient care costs. Programs with lower transplant volumes may feel these impacts more acutely because the fixed costs of maintaining transplant infrastructure don’t scale down proportionally.
As transplant administrators we’re having conversations nationally, looking at ways to optimize financial sustainability while we continue to prioritize patient access and high-quality care. If we need to go across the country to get an organ, how are we acquiring it in a cost-effective manner?
Q: What strategies has Tufts implemented to ensure sustainability while maintaining high-quality patient care?
SK: It’s been a multi-pronged approach for us as we’ve expanded all of our solid organ transplant services.
We have one arm that is really focused on operational efficiency: optimizing workflows, streamlining the way that we’re reviewing organ offers and expanding different recovery techniques.
Then we’ve looked really closely at procurement logistics. We’ve leveraged partnerships with recovery teams that are more local to the donor as opposed to deploying our teams to fly across the country. We’ve partnered with aviation providers and logistics experts to really help us explore the most cost-effective way to transport that organ back to Tufts.
As more of a high-level approach, at Tufts we’ve also integrated financial considerations into our quality program, ensuring that our cost-efficiency measures align with patient outcomes rather than compromise them.
We’ve also collaborated more closely with payers. I participate in different policy groups and advocate for a reassessment of transplant reimbursement structures because I think they need to be revisited to truly reflect the modern realities of organ acquisition. Reimbursement methodologies in solid organ transplant have not evolved at the pace that our technology and advancements have.
Q: Are there any policy changes or advocacy efforts you believe could help mitigate the financial burden of organ acquisition on hospitals and transplant centers?
SK: As we all adjusted to the national allocation policy changes, programs are starting to recognize these increased organ acquisition costs. Various groups are gathering together to revisit reimbursement models because they just haven’t evolved in parallel with these shifts.
Right now these efforts are driven more at the program level, with each center determining how they deploy teams, adopt technologies, and continue to foster greater collaboration with local partners and organ procurement organizations.
The way we can create a more cost-effective, scalable and equitable system is by ensuring all transplant programs, including smaller rural programs, can continue to acquire organs despite rising costs.
Could there be public-private collaborations that establish national frameworks for optimizing aviation resources that mitigate unnecessary expenditures? Right now, each transplant center is either acquiring and using their own internal jets or partnering with different aviation services to be able to both move teams and move organs around the United States.
I’m a huge proponent of having national conversations around developing centralized logistic models, and broader partnerships with aviation providers and regulatory bodies, that focus on cost-effective transportation without compromising the speed of travel or organ integrity.
Q: What innovative approaches or partnerships have you seen emerge to address the rising costs while still expanding access to transplantation?
SK: Beyond logistics, which I focused a lot on today, it’s really the strategic application of advanced perfusion and preservation technologies that present another avenue for cost containment. The challenge for transplant centers and clinical teams is not just simply adopting the most advanced technology but really selecting the right technology for the right circumstance, for the right transplant.
Years ago organs were put into Igloo coolers. Now we’re shifting to growing evidence that ex vivo perfusion helps organ utilization rates, which potentially offsets procurement costs. Integration of these technologies into transplant workflows needs to remain thoughtful so as to maximize the benefits while maintaining financial sustainability.
One key area that we have adopted at Tufts is NRP, normothermic regional perfusion, which helps expand the donor pool. Early data is showing it improves organ function. As programs like ours are adopting NRP into procurement protocols, we could potentially see a paradigm shift in organ recovery, potentially reducing our reliance on very expensive perfusion devices while also improving our utilization of more marginal organs.
The goal for transplant programs is to create a cost-effective, scalable, equitable system that benefits both patients but healthcare institutions.
