Future Cost Considerations for Organ Transplants
Forecasting the complicated medical needs of individuals leading up to and following organ transplants requires careful attention to detail. Organ transplant candidates are often some of the most acutely ill evaluees life care planners encounter. These patients require vigilant medical surveillance prior to transplant, must endure the stress and fear of being taken off the waiting list, and must be close enough to a transplant center to respond to available transplant organs at a moment’s notice. Given the complexity of the transplant surgery itself, the iatrogenic effects of lifetime immunosuppressant medications, and the multitude of potential complications, collecting reliable cost estimates for transplants can be challenging.
The United Network for Organ Sharing (UNOS) is a private, non-profit organization that manages the national organ transplant system. UNOS through its Organ Procurement and Transplantation Network (OPTN), matches donors to recipients, manages the waiting lists, develops policies, evaluates procedures, and most importantly, maintains a database on every transplant performed in the United States. This comprehensive database allows for detailed research regarding the typical costs for single-organ, double-organ, or tissue transplants.
Milliman is an independent risk management, benefits, and technology firm that publishes the most comprehensive analysis of transplant costs in the United States. The firm issues an updated study every three years, with the most recent being published in January of 2020. The Milliman report includes transplant costs that cover the 30-day period prior to the transplant, the cost for organ procurement, the cost of the actual transplant (includes medical and hospital fees), and the costs associated with the first 180 days following the transplant. The report presents costs in several ways including the PMPM (per member per month) and the “billed” charge. It is the billed charge that is appropriate for use according to generally accepted standards of practice for life care planning.
As costs are limited to specific pre- and post-transplant time frames, it is important to collaborate with the treating or consulting specialist to address likely costs that extend beyond the 180 days after transplant. As mentioned in a previous post, issues such as organ rejection, infectious diseases, and side effects of immunosuppressant medications, can put organ recipients in the position of “trading one disease for another.” Additionally, the issue of mortality rates and life expectancy following transplants requires strong medical foundation and consultation.
Life care planning for transplant cases can be complicated. Future care involves multiple bodily systems, frequent medical complications, and varied side effects from the lifelong medications required to avoid organ rejection. It takes an experienced team to accurately plan for and reliably research the cost of future care.