PROMOTING ORGAN DONOR REGISTRIES THROUGH PUBLIC EDUCATION CAMPAIGNS: WHAT IS THE COST OF SECURING FUTURE ORGAN DONORS?

Purpose: To analyze the cost of enrolling one individual into the organ donor registry, and by extension, to analyze the cost of securing one organ donor for future.

Method: This analysis was conducted from the perspective of an organ procurement organization (OPO). The cost of promoting the donor registry was obtained from the OPO’s public education budget. Data on new registrants were obtained from the departments of motor vehicles quarterly reports and the OPO’s in-house database. Analysis was conducted under two scenarios: 1) first-person authorization where the OPO honors the decedent’s wishes; and 2) family-authorization where the OPO defers the donation decision to the decedent’s family. We used Markov analysis to model a registrant’s ongoing and time-variant risk of dying and becoming an organ donor as a function of the registrant’s age of joining the registry. The model was run until all registrants died and either became a donor or not. Monte Carlo probabilistic sensitivity analysis was used to determine the 95% confidence limits around the number of new registrants, number of donors secured and the cost of securing one registrant and one donor. A social discount rate of 3% was used to calculate the present-day value of future donors. Model parameters were either obtained from published literature or from analysis of the OPO’s decedent data.

Result: Over the three year period from 2010 to 2012, an estimated 6,708 additional individuals joined the state donor registries (95% CI: 4,783, 8,544) at a cost of $455 per registrant (95% CI: $357, $638). Under the first-person authorization model, these new registrants would result in 8.3 future donors or 4.2 present-day donors (95% CI: 2.3, 6.9). The cost of one present-day donor under this model was $726,000 (95% CI: $442,000, $1.3 million). Under the family authorization model, the new registrants would result in 5.4 future donors or 2.8 present-day donors (95% CI: 1.2, 4.9) at an estimated cost of $1.1 million per donor (95% CI: $622,000, $2.5 million).

Conclusion: When compared to society’s willingness to pay $478 for a 65 year old registrant (Howard and Byrne, 2007) and $1.1 million for one donor (Mendeloff et al., 2004), our estimates suggest that the OPO's public education strategy is a good investment.