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Perfusion fluids Cost and Economics
Dr.R.V.Raghavendra Rao M.S,M.Ch(SGPGI),FHPB,FLT(SNUH)
Consultant Surgical Gastroenterologist and Liver Transplantation SurgeonHyderabadMob:9866458511Email: [email protected]
Perfusion fluids Cost and Economics
The issue which has swept down the centuries and which will have to be fought sooner or later is the people versus the banks -Lord Acton
Perfusion fluids Cost and Economics
perfusion /per·fu·sion/ (-zhun)
The act of pouring over or through, especially the passage of a fluid through the vessels of a specific organ.
Dorland's Medical Dictionary for Health Consumers
per·fu·sion (p r-fy zh n)
The injection of fluid into a blood vessel in order to reach an organ or tissues, usually to supply nutrients and oxygen The American Heritage® Medical Dictionary
Perfusion fluids Cost and Economics
Commonly used fluids
University of Wisconsin (UW) solution
HTK Solution
Renograph / Marshal
Celsior - mainly cardiac
Perfadex – mainly pulmonary
Perfusion fluids Cost and Economics
Cost factors
Varies from INR 3500 to 26000/- per litre
Depends on
-Type of Fluid
-Import regulations
-Quantity (1lit vs 5 lit bags)
-Availability
Perfusion fluids Cost and Economics
Factors to be considered in cost analysis
Logical efficiency
Immediate graft function
Delayed Graft function
Spectrum of usage
Perfusion fluids Cost and Economics
Cost comparision between two commonly used solutions (UW vs HTK)
University of Pittsburg research report 2003
Alonso D, etal. Am J Transplant. 2008;8:1942-1945
StewartZA, et al. Am J Transplant. 2009;9:217-221
Robert J Stratta 2009
-UW 0n average USD 137.6 costlier than HTK/ Pt
Perfusion fluids Cost and Economics
A typical case (Involving Kidney and Liver)
Aorta perfusion - Marshal - 10000/-
(3lit) Portal perfusion - UW solution - 52000/- HTK - 48000/-
(1lit+1lit) (6lit)
Cold preservation-UW solution - 26000/- -8000/- (1lit)
Perfusion fluids Cost and Economics
Considerations for selection of perfusant to reduce costsSingle organ or multiorgan harvesting
DDLT vs LDLT
Brain Dead Vs NHBD
Standard or Extended criteria donors
Expected cold ishaemia time
Availability of solution
Perfusion fluids Cost and Economics
Factors which increase the cost of a preservative solution
Maintance of cold chain
Need for additional products before usage
Wastage during solution packaging
Perfusion fluids Cost and Economics
Recent DevelopmentsMachine perfusionCosts on average USD 3000 more
Moers, c. et al N. Engl. J. Med. 360, 7-29 (2009)
Buchanan, P. M. et al. Am. J. Transplant. 8, 2391-2401 (2008).
Gerrfield ss, et al. Tranplant proc.2009
Nov;41(9) : 3531-6
Perfusion fluids Cost and Economics
Reducing the costs
S selection of Donor
E
L Low volume flush (?)
E Efficiency
C Coordination between teams
T Transportation