Work

Modeling the cost-effectiveness of introducing donation after controlled circulatory death for heart transplantation in France

Year: 2026

Type: article

Abstract: Heart transplantation following donation after controlled circulatory death (DCD) could alleviate the global shortage of organs. We assessed the cost-effectiveness of this strategy and outlined the factors enabling an efficient DCD heart program. Two strategies were compared: donation after brain death (DBD) using static cold storage vs. DBD + DCD transplantation, where DCD hearts are preserved with a normothermic ex situ perfusion system. Costs (€; 2024 value) and outcomes (quality-adjusted life years (QALYs)) were modelled through a 15-year time horizon. Our main assumption was that DCD would increase transplant access without affecting waitlist mortality, with equivalent post-transplant outcomes. With a 20% annual increase in transplant activity, the DBD + DCD strategy resulted in a mean incremental gain of 0.14 QALYs at an additional cost of €20,618 compared with DBD alone. The incremental cost-effectiveness ratio was €146,373 per QALY gained. An 8% relative reduction in waitlist mortality (i.e., four additional lives saved annually among 500 new waitlisted patients) would make the DCD heart program cost-effective at €100,000 per QALY. Lower consumable costs would further improve cost-effectiveness. Decision-makers should consider these findings in light of the disease severity and the persistent shortage of heart donors that could be alleviated with DCD.

Source: Transplant International

DOI: 10.3389/ti.2026.17149

Authors: Jamal Atfeh, Pascale Guerre, Julien Guihaire, Laurent Sebbag, Matteo Pozzi, Laure Huot