The Economic Impact of the Utilization of Liver Allografts with High Donor Risk Index


*Corresponding author: David A. Axelrod,


The disparity between the organ supply and the demand for liver transplantation (LT) has resulted in the growing utilization of ‘marginal donor’ organs. While economic outcomes for subsets of ‘marginal’ organs have been described for renal transplantation, similar analyses have not been performed for LT. Using UNOS data for 17 710 LTs performed between 2002 and 2005, we assessed the relationship between recipient model for end-stage liver disease (MELD) score, organ quality as defined by donor risk index (DRI, Feng et al. 2005) and hospital length of stay (LOS). Single-center cost-accounting data for 338 liver transplants were then analyzed with a multivariate linear regression model to determine the estimated cost associated with a day of LOS. Overall, 8.4% of donor organs were classified as high risk (DRI > 2–2.5) and 1.9% as very high risk (DRI > 2.5). In the lowest MELD group (0–10), the LOS difference between ‘ideal’ donors (DRI < 1.0) and very high risk (DRI > 2.5) was 10.6 days which was associated with an estimated incremental cost of $47 986. For patients with MELD >35, the average LOS increased from 23.2 to 41.8 days when very high DRI donors were used, resulting in an estimated increase in cost of nearly $84 000. We conclude that the use of marginal liver grafts results in increased hospital costs independent of recipient risk factors.