Organ Transplant Innovations Can Save Health Care Dollars

By Barbara Rutkowski, Yvonne Daugherty

Dec. 12, 2018

More than 114,000 Americans are on the organ transplant list and about 20 people die each day waiting for a transplant. Expanding the pool to allow organs to be transplanted that were previously discarded can reduce suffering, save lives and, in many cases, reduce high disease-related medical costs for self-insured employers, insurers and patients.Organ Transplant Innovations

One way the pool is beginning to expand is by allowing organs to be transplanted from donors with hepatitis C. Thankfully, the same medications that offer a cure for those affected by chronic hepatitis are also being utilized to help patients eagerly awaiting organ transplants.

At first blush, this may seem like a dangerous idea, but if proper protocols are followed it can be safe and help save lives. Receiving an organ from a donor with hepatitis C allows the patient to live a healthier life. It also saves both them and their health plan the significant cost of ongoing disease treatment (such as dialysis) while they wait for a transplant.

But it’s up to patients, their physicians, the stop-loss carrier and health plan administrators to work together proactively to determine if this course of action is right for them. Brokers and consultants can help by educating employers about this treatment opportunity.

Why Infected Organs Can Now Be Donated

In the past, organs from donors with hepatitis C (called HCV-infected) were discarded. But advances in drug development mean that antiviral drugs can cure those with hepatitis C — including transplant recipients. Organs from HCV-infected patients are also becoming more readily available for transplant because of the growing number of deaths associated with the opioid crisis.

A patient can now receive an organ from an HCV-infected patient, and if they show signs of hepatitis C, they can be treated with antiviral medications for eight to 12 weeks following the transplant. Before undergoing the transplant, recipients must be able to tolerate the hepatitis C medication, which is usually tested pre-operatively.

One Cost-Saving Example: The High Cost of Kidney Disease

More than 102,000 people on the transplant waiting list need kidneys. The total cost of a kidney transplant is significantly lower than the $350,000 to $700,000 a plan sponsor or health plan pays annually to care for individuals on dialysis. More importantly, in many cases, using organs from HCV-infected patients is a lifesaving procedure for those on the waiting list who otherwise would not have survived long enough to receive a donated kidney. The average wait time for a kidney from a non-HCV-infected patient is more than two years, while the wait for a kidney from an HCV-infected patient is just eight months.

Also read: 4 Tips on How to Conduct a Voluntary Benefits Checkup

Kidneys from HCV-infected donors can extend life and improve quality for more organ recipients. It’s one example of how innovative practice and revolutionary pharmacology have eradicated the HCV infection, making the reality of transplant available to so many more people.

Transplant Success Stories

Medical teams and patients have seen success transplanting organs from patients infected with hepatitis C. The University of Pennsylvania has successfully transplanted 20 kidneys from HCV-infected patients since 2016, and all patients who received these organs are free of hepatitis C.

Medical teams have seen success with other organs, too. Vanderbilt Transplant Center has transplanted 44 hearts from HCV-infected patients, the largest number done by any transplant center to date. Of 37,795 total organs transplanted in 2017, 1,491 tested positive for a hepatitis C infection. In the first half of 2018, 803 transplanted organs tested HCV positive.

What Brokers and Employers Should Know

With treatment for hepatitis C widely available, an increasing number of health plans are supporting the transplantation of organs from hepatitis C-infected donors to those who are not infected. Just as they would for a typical transplant, a health plan medical director and a transplant coordinator review each case individually for medical necessity, patient condition, organ quality, the best course of action and transplantation at a center of excellence. Brokers should educate employers on this development, and whether their specific health plan covers this time- and money-saving procedure.

For now, it’s up to employees or health plan administrators to work with physicians to determine if it’s an appropriate solution. In many cases, a transplant with an organ from an HCV-infected patient is better for the recipient and better for the health plan.

Barbara Rutkowski is the vice president of clinical operations at Advanced Plan for Health, a Texas-based health care company that focuses on managing risk and optimizing health care benefits and costs.

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