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Background: Heart transplantation is an established treatment for end-stage heart failure patients, but its cost-effectiveness is under question. Objective: This study aimed to assess the cost of heart transplantation in Iran as a developing country in Asia to contribute to future planning in the region. Methods: This study was conducted in two phases. First, in a retrospective multicenter study, hospital data of heart transplant and hospitalization of three active heart transplant centers in Tehran, Iran, were reviewed from April 2013 to May 2015. Then pre-transplantation, transplantation, and one-year posttransplant costs were calculated according to the ABC (activity-based costing) method in 2016. Results: Data were obtained for 120 patients, among which 95 (79.17%) were males with a mean (SD) age of 35.31±13.41 years. Mean (SD) hospital and ICU length of stay were 17.85±14.91 and 9.74±8.94 days, respectively. A significant correlation existed between the mean of hospital and ICU length of stay (P<0.001, r: 0.754). The mean heart transplant and hospitalization cost was 3445.47±1243.29 USD from 2013 to 2015. Using the activity-based costing method, the cost of pre-transplantation, transplantation, and one-year -post-transplantation were extracted 6.5%, 73.5%, and 20%, respectively, with a total cost of 26232 USD. Conclusion: Compared to other countries, the cost of heart transplantation in Iran is very low. Numerous reasons lead to this difference. Firstly, a heart transplantation surgery is performed in university-based hospitals and is supported by the government. On the other hand, a significant difference exists between personnel costs in Iran compared to other countries.
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INTRODUCTION: Brain-dead patients are almost the only source of organs for lung transplantation, and lungs fall within the area of the least harvested organs. As a result, maintaining the highest possible harvest rate is a must for the lung transplantation system. In the present study, the harvest rate of lungs and also the causes of failure to donate the lungs is reported for brain-dead patients in our organ procurement unit. MATERIALS AND METHODS: After going through the brain-death database at our organ procurement unit between 2004 and 2008, we included all 93 brain deaths in this hospital. The lung donation rate was reviewed to examined the causes for failure to donate lungs. RESULTS: From the total brain-dead patients registered in the database, only 4 (4.6%) patients donated their lungs. The causes of failure to donate a lung were not suitable lungs among 78 (83.8%) because they had an unacceptable oxygen challenge test results (<300 mm Hg). Another 11 patients had acceptable oxygen challenge test results, but donation failed in their case as well due to most frequently to pulmonary aspiration. CONCLUSION: In this center, only a small percentage of lungs are appropriate for harvest in brain-dead patients, because many patients' lungs do not meet the criteria with unacceptable oxygen challenge test results. Patients with proper test results may fail to donate lungs due to pulmonary aspiration. More aggressive care of the patients may have an important role in keeping them in good condition and helping to preserve the organs for harvest. For this purpose, further training of intensive care unit staff and physicians are among the suggested steps to enhance the quality of care, which in turn can maximize the lung harvest rate.
