Modeling the cost-effectiveness of introducing donation after controlled circulatory death for heart transplantation in France
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.
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BibTeX
@article{atfeh2026modeling,
title = {{Modeling the cost-effectiveness of introducing donation after controlled circulatory death for heart transplantation in France}},
author = {Jamal Atfeh and Pascale Guerre and Julien Guihaire and Laurent Sebbag and Matteo Pozzi and Laure Huot},
journal = {Transplant International},
year = {2026},
month = sep,
doi = {10.3389/ti.2026.17149},
url = {https://hal.science/hal-05799802v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Modeling the cost-effectiveness of introducing donation after controlled circulatory death for heart transplantation in France
AU - Jamal Atfeh
AU - Pascale Guerre
AU - Julien Guihaire
AU - Laurent Sebbag
AU - Matteo Pozzi
AU - Laure Huot
PY - 2026
DA - 2026/09/09
JO - Transplant International
DO - 10.3389/ti.2026.17149
UR - https://hal.science/hal-05799802v1
AB - 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.
SN - 0934-0874
SN - 1432-2277
ER -