More donors or more delayed graft function? A cost‐effectiveness analysis of DCD kidney transplantation

Expansion of the donor pool with expanded criteria donors and donation after cardiac death (DCD) donors is essential. DCD grafts result in increased rates of primary non‐function (PNF) and delayed graft function (DGF). However, long‐term patient and graft survival is similar between donation after brain death (DBD) donors and DCD donors. The aim of this study was to evaluate the cost‐effectiveness of the use of DCD donors. A Markov‐based decision analytic model was created to simulate outcomes for two wait list strategies: (i) wait list composed of only DBD organs and (ii) wait list combining DBD and DCD organs. Baseline values and ranges were determined from the Scientific Registry of Transplant Recipients (SRTR) database and literature review. Sensitivity analyses were conducted to test model strength and parameter variability. The wait list strategy consisting of DBD donors only provided recipients 5.4 Quality‐adjusted life years (QALYs) at $65 000/QALY, whereas a wait list strategy combining DBD + DCD donors provided recipients 6.0 QALYs at a cost of $56 000/QALY. Wait lists with DCD donors provide adequate long‐term survival despite more DGF. This equates to an improvement in quality of life and decreased cost when compared to remaining on dialysis for any period of time.     

Editorial Commentary: Triple-Bundle Anterior Cruciate Ligament Reconstruction: More Is More or Less Is More?

We need ambitious pioneers to explore the frontiers of surgical technique, but the surgeons that follow are wise to wait for independent and robust evidence of clinical benefit. Double-bundle anterior cruciate ligament reconstruction has struggled to establish its role, and triple-bundle reconstruction is perhaps even less likely to gain widespread acceptance, given that cadaveric research has shown only a small biomechanical advantage over a double-bundle or even a single-bundle technique and there is no convincing evidence of improved clinical outcomes.