organ acquisition would be increased under broader sharing because of the sharing of organs over a greater geographical area. However, the committee was unable to estimate the magnitude of this change, given uncertainties about how the Final Rule will be implemented, how much larger the new geographical areas will be and how they will affect travel times, and how the organ acquisition practices of transplant centers might change over time. The potential increase might appear significant in absolute dollars. However, as shown in Table 7-3, expenditures for procurement are a relatively minor component of overall expenditures for transplantation. Therefore, such an increase would likely have a marginal impact on total cost.

The committee confined its analysis to the expenses and expenditures directly associated with organ acquisition and transplantation. It did not attempt to evaluate other aspects that might appropriately be taken into consideration, such as the value of additional lives saved for status 1 and status 2A patients who receive a transplant or the cost of additional years of impaired health incurred by status 3 patients who do not receive a transplant.

Expenditures for organ procurement and transplantation are likely to increase as a result of broader sharing. The committee is not, however, able to estimate with confidence how large the increase might be because it is not clear how the Final Rule will be implemented and how many patients in each status will be affected. In addition to transportation expenses, implementation will alter multiple factors affecting transplant expenditures. These factors can vary widely from one case to another. Any increase in expenditures must, however, be weighed against the additional health benefits gained through broader sharing, which the committee believes will be substantial and could outweigh any net increase in expenditures.