CG 7 Posthumous organ donation

CG 7.1 Scope

CG 7.1.1 This Costing guideline relates to posthumous organ donation to transplantation, where a patient is formally discharged upon death (brain death or cardiac/circulatory death) and reclassified as a posthumous care episode.

CG 7.1.2 This Costing guideline does not relate to live donation (such as kidney donation).

CG 7.2 Objective

CG 7.2.1 This Costing guideline outlines the nationally consistent approach to costing posthumous organ donation.

CG 7.2.2 This Costing guideline clarifies the three types of episodes to be considered when allocating costs related to posthumous organ donation. These should be considered in order to support a nationally consistent costing approach.

CG 7.2.3 IHPA acknowledges that there are sensitivities and limitations to costing posthumous organ donation, due to patient privacy. IHPA will work with stakeholders to provide further clarification to standardise costing of posthumous organ donation.

CG 7.2.4 It is recognised that the timing of circulatory death may be difficult to identify precisely in the clinical notes; at the time of publishing, the Australian Institute of Health and Welfare (AIHW) is reviewing definitions of care type which may facilitate definition and reporting of the posthumous care period.

CG 7.3 Costing guideline

CG 7.3.1 The following three episodes should be considered in posthumous organ donation:

  • Donor episode
  • Posthumous care episode
  • Recipient episode

Donor episode

CG 7.3.2 Costing practitioners should consult with their relevant clinicians such as intensivists to understand the pathway for posthumous care including the resources and time taken to prepare the donor for the retrieval process.

CG 7.3.3 External revenue or funding from third party sources (such as DonateLife), should not be offset against expenses. Furthermore, costs of maintaining donor are to be allocated to the donor hospital.

Posthumous care episode

CG 7.3.4 The costs of preparation for posthumous organ donation are allocated to the posthumous episode under ‘care type 9 – organ procurement – posthumous’.

CG 7.3.5 The Costing Practitioner should consider the following resources for the posthumous care episode:

  • Setting (generally intensive care)
  • Medical/clinician
  • Nursing
  • Drugs
  • Other resources (such as pathology)

Recipient episode

CG 7.3.6 The costs of organ retrieval are allocated to the transplantation patient episode at the same or other hospital under ‘care type 1 – acute care’.

CG 7.3.7 Costs of retrieval are to be allocated to the recipient. The Costing Practitioner should consider the following resources when costing the retrieval process:

  • Surgeon
  • Assistant Surgeon
  • Theatre Technician/Perfusionist
  • Medical supplies
  • Drugs
  • Perfusion fluids
  • Goods and services
  • Mode of transport (especially high cost flight for external retrievals)
  • Organ cold storage
  • Transplantation coordinator
  • Transplantation service/departmental costs

CG 7.3.8 Costing practitioners should also discuss the relevant procedure time taken in the retrieval process. For example, on average these procedures may take 4-6 hours, with additional time required for travel. Retrieval may occur after hours and consideration should be given to additional expenses (such as staff salaried loadings) in an afterhours setting.

CG 7.3.9 The recipient episode, with respect to the transplantation, should be costed as per all other activity. Costing practitioners should, however, also seek to understand the nuances of this process. For example, they should seek to ensure:

  • the correct theatre time is available within the theatre system for feeder purposes as these procedures have significant durations
  • the appropriate surgical teams are recognised within the transplantation process. In some instances, and depending upon the procedure, up to 3 surgical teams may be collocated within the theatre at any given time.
  • relevant medical supplies and goods and services required for transplantation.