OBJECTIVES: Donor organs for transplant and human blood are scarce resources; this study aimed to establish if and how a reduction in the use of donor organs is valued in health technology assessments (HTA).

METHODS: Literature searches were conducted to identify interventions that may reduce or delay the number of organ transplants required within a general population. HTA decisions for these interventions published within the last five years by the National Institute for Health and Care Excellence or the Canadian Agency for Drugs and Technologies in Health were reviewed to determine whether this outcome was discussed and/or valued. PubMed hed for methods, published within the last 5 years, to quantify the indirect value (reduction in opportunity cost) of an intervention to delay or avoid kidney transplant to patients on waiting lists.

RESULTS: Eighteen medicines and four devices or procedures associated with reducing or delaying the need for kidney, liver, lung transplants or preserving donor organs were found. Medicines included those for kidney disease (n=6), liver disease (n=3), cystic fibrosis (n=3), and organ transplant (n=4). Of the 31 HTA decisions reviewed, five mentioned donor organs being scarce, valuable, or limited resources, while two mentioned equity issues relating to organ transplants. While delay in time to, or absolute reduction in organ transplants was included as an outcome of interest in some economic models, none considered the indirect benefit to patients on waiting lists who would get an earlier transplant. No articles describing methods for valuing this type of indirect benefit were identified.

CONCLUSIONS: While the quality of life and cost benefits to patients and healthcare systems of delaying or avoiding an organ transplant is captured in some way within economic models, the indirect benefit to patients on waiting lists does not appear to be considered at HTA.