Abstract

BACKGROUND: The goal is to provide a national analysis of OPO costs.METHODS: Five years of data, for 51 of the 58 OPOs (2013-17, a near census) were obtained under a FOIA. OPOs are not-for-profit federal contractors with a geographic monopoly. A generalized 15-factor cost regression model was estimated with adjustments to precision of estimates (p-values) for repeated observations. Selected measures were validated by comparison to IRS forms.RESULTS: (p=0.05) DD organ procurement is a $1B/yr. operation with over 26000 transplants/yr. Over 60 percent of the cost of an organ is overhead. Profits are $2.3M/OPO/yr. Total assets are $45M/OPO and growing at 9%/yr. "Tissue" (skin, bones) generates 2 to 3$M profit/OPO/yr.A comparison of the highest with the lower costing OPOs showed our model explained 75% of the cost difference. Comparing costs across OPOs showed that highest cost OPOs are smaller, import 44% more kidneys, face 6% higher labor costs, report 98% higher compensation for support personnel, spend 46% more on professional education, have 44% fewer assets, compensate their executive director 36% less, and have a lower procurement performance (SDRR) score.CONCLUSIONS: Profits and assets suggest that OPOs are fiscally secure and OPO finances are not a source of the organ shortage. Asset accumulation ($45M/OPO) of incumbents suggests establishing a competitive market with new entrants is unlikely. Kidney cost allocations support tissue procurements. Professional education spending does not reduce procurement costs. OPO importing of organs from other OPOs is a complex issue possibly increasing cost ($6K/kidney).Supplemental visual abstract; http://links.lww.com/TP/C135.

View details for DOI 10.1097/TP.0000000000003667

View details for PubMedID 33988344