Roger W. Evans

The Economic Implications of Noninvasive Molecular Testing for Cardiac Allograft Rejection

Endomyocardial biopsy is the mainstay for monitoring cardiac allograft rejection. A noninvasive strategy—peripheral blood gene expression profiling of circulating leukocytes—is an alternative with proven benefits, but unclear economic implications. Financial data were obtained from five cardiac transplant centers. An economic evaluation was conducted to compare the costs of outpatient biopsy with those of a noninvasive approach to monitoring cardiac allograft rejection. Hospital outpatient biopsy costs averaged

Ethnocentrism Is an Unacceptable Rationale for Health Care Policy : A Critique of Transplant Tourism Position Statements

3297, excluding reimbursement for professional fees. Costs to Medicare and private payers averaged

Machine perfusion cost‐effectiveness versus cold storage has been demonstrated; limiting use to marginal donor kidneys unjustified

3581 and

The Sarah Murnaghan debacle: A health policy perspective on transplant candidate selection

4140, respectively. A noninvasive monitoring test can reduce biopsy utilization. The savings to health care payers in the United States can be conservatively estimated at approximately

A cost effectiveness analysis of organ preservation methods for deceased donor kidneys at high risk for delayed graft function in Brazil

12.0 million annually. Molecular testing using gene expression profiling of peripheral circulating leukocytes is a new technology that offers physicians a noninvasive, less expensive alternative to endomyocardial biopsy for monitoring allograft rejection in cardiac transplant patients.

Economic evaluation in health care: A modern day quagmire

Medical tourism has emerged as a global health care phenomenon, valued at

Vital Role of Medical Examiners and Coroners in Organ Transplantation

60 billion worldwide in 2006. Transplant tourism, unlike other more benign forms of medical tourism, has become a flashpoint within the transplant community, underscoring the uneasy relationships among science, religion, politics, ethics and international health care policies concerning the commercialization of transplantation. Numerous professional associations have drafted or issued position statements condemning transplant tourism. Often the criticism is misdirected. The real issue concerns both the source and circumstances surrounding the procurement of donor organs, including commercialization. Unfortunately, many of the position statements circulated to date represent an ethnocentric and decidedly western view of transplantation. As such, the merits of culturally insensitive policy statements issued by otherwise well‐intended transplant professionals, and the organizations they represent, must be evaluated within the broader context of foreign relations and diplomacy, as well as cultural and ethical relativity. Having done so, many persons may find themselves reluctant to endorse statements that have produced a misleading social desirability bias, which, to a great extent, has impeded more thoughtful and inclusive deliberations on the issues. Therefore, instead of taking an official position on policy matters concerning the commercial aspects of transplantation, international professional associations should offer culturally respectful guidance.

Coming to Terms with Reality: Why Xenotransplantation Is a Necessity

In their review of machine perfusion (MP) versus cold storage (CS), Yuan et al. [1] recommend that pulsatile perfusion should be currently focused on marginal donor organs. They further conclude that ‘costs have recently increased when utilizing MP and previous studies on economics and organ preservation may need to be revisited prior to expanding the utilization of MP to all organs.’ We take exception to the recommendation of Yuan et al., and provide convincing evidence relative to their conclusion. As suggested by Yuan et al., as well as others, we modeled the cost-effectiveness of MP versus CS based on the clinical outcomes reported in the Machine Preservation Trial (the only published prospective randomized clinical trial comparing CS versus MP), incorporating recent price increases for MP in the United States [1–4]. We found that at 1-year post-transplant, MP is a more cost-effective option than CS for organ preservation in transplants involving either standard criteria donor (SCD) (

Economic impact of mechanical cardiac assistance

92 561 vs.

Financial, Economic and Insurance Issues Pertaining to Intestinal Transplantation: When is too much not enough?

104 118) or extended criteria donor (ECD) (