Clinical Gains, Financial Strains: Evaluating the TransMedics OCS in Donation After Circulatory Death Liver Transplants

Document Type

Conference Proceeding

Publication Date

1-1-2026

Publication Title

Am J Transplant

Abstract

Introduction: Organ transplantation is among the most resource intensive interventions in healthcare, and often utilizes expensive technological innovations that do not have congruent financial accountability to the clinical outcomes they acquire. This study provides a thorough value-based assessment of one such intervention, the TransMedics Organ Care System (OCS), in liver transplantation specifically focused on donation after circulatory death (DCD) organ donation assessments in an integrated academic health system over a three-year period. Methods: This study is a retrospective comparative analysis to evaluate the clinical and financial outcomes of liver transplants without OCS (n=23) and transplants with OCS (n=42). Financial data was taken from institutional cost-accounting records to measure direct surgical costs, device and perfusion costs, net patient revenue, and complication-associated expenses. Patient outcomes were collected to compare postoperative complication rates, bile duct injuries, re-transplantation rate, and mortality. Results: Clinically, the addition of TransMedics OCS resulted in improved outcomes where complications decreased from 52% to 36%, bile duct complications decreased from 48% to 29%, 90-day mortality decreased to 0%, and 1-year mortality decreased to 0%. Additionally, re-transplantation rates were completely eliminated by 2024. Operationally, total liver transplants increased by 82.6% from 23 in 2021 to 42 in 2024. Financially, the addition of the OCS increased total costs of a procedure by an estimated $107,000-$119,000. Average per-case margin dropped from a positive margin of $43,000 in 2021 to a negative margin of $36,000 in 2024. While the costs per case initially increased, complication related costs per case decreased by more than 55% supporting greater efficiency and less than post-acute resource utilization. Conclusion: The findings of our study suggest that TransMedics is associated with lower ICU days, readmissions, and the need for resource-intensive recovery procedures. TrasnsMedic cases may appear financially unfavorable when evaluated solely through procedural reimbursements, but is clinically valuable with significant reduction in complication net revenue. Our study encourages the use of TransMedics as it aligns with long term institutional values which accounts for both improved patient outcomes and system sustainability.

Volume

26

Issue

1

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