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]dc Fuslkcss ni Alvcr]rjkspajktjtlnk

Vnfcrt _. Frnwk, Gr., HM, HPD

Jssnoljtc Prnicssnr ni Hcmlolkc & _urbcry

Odlci, Mlvlslnk ni Alvcr Mlscjsc & ]rjkspajktjtlnkOnauhflj Sklvcrslty Onaacbc ni Pdysloljks & _urbcnks

Kcw \nre-Prcsfytcrljk Dnspltja

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L djvc kn ilkjkolja rcajtlnksdlps tn

mlsoansc wltd lk tdc pjst :6 hnktdsrcacvjkt tn hy prcscktjtlnk

Hy prcscktjtlnk mncs knt lkoaumcmlsousslnk ni nii-ajfca nr lkvcstlbjtlnkja

usc

Vnfcrt _. Frnwk, Gr., HM, HPD

8/13/2019 The Business of Liver Transplantation

3/27

Rdncvcr ynu jrc--L djvc jawjysmcpckmcm nk tdc elkmkcss nistrjkbcrs

]ckkcsscc Rlaaljhs

Hnttn ni ]rjkspajkt DcpjtnanbyKnw

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Oalkloja Dcpjtnanby lk 6003Odjaackbcs

_dnrtjbc djrm wnre jkm onbkltlvc--icaanws wjkt hnrc prnocmurcs

Onbkltlvc onaacotlnks1onstKccm tn mcpckm nk ntdcr lkonhc snurocs

BL Mlvlslnk rcvckuc

Mnlkb BL--ojkklfjalzc prnocmurcs irnh rcicrrlkb

HMs Vcscjrod

]rjkspajktjtlnk

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]rjkspajkt ls tdc fcst jkswcr js ltprnvlmcs j iuaa rjkbc ni tnnas tndcpjtnanblst fut kccm tn hjec tdckuhfcrs wnre

Jmcqujtc stjiilkb -- prcvckt furknut

Jmcqujtc ilkjkocs

Li ynu fulam lt (rlbdt) tdcy wlaa onhc

Oalkloja Dcpjtnanby lk 6003_nautlnks

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Alvcr trjkspajktjtlnk7 wdy>

Dnspltjas wjkt tdls scrvloc --onhprcdckslvc trjkspajkt ocktcr

Alvcr trjkspajkt prnbrjhs hjecdnspltjas hnkcy jkm lhprnvc qujaltyni ojrc

Ojtjayzc trjksajtlnkja jkm fjslorcscjrod

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Alvcr ]rjkspajktjtlnkDnw tn jiinrm lt>

Dcpjtnanblsts onaacotlnks1onst

Mrjlk nk BL ojk acjms tn slbklilojkt

rlitsDcpjtnanblsts bckcrjtc slbkl i lojkt

lkonhc inr Dnspltja

_urbcry, jkcstdcslj

Vjmlnanby

Ckmnsonplsts, ojrmlnanby

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Djvc nkay surbcnks

Bct Dnspltja suppnrt inr

dcpjtnanblsts Lhprnvc onktrjotlkb

Orcjtc jk lktcbrjtcm fuslkcss ukltwltd surbcnks jkm dnspltja

Kccm tn hnvc fcynkm plcoc-wnrehcktjalty

Alvcr ]rjkspajktjtlnkDnw tn jiinrm lt>

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Alvcr Mlscjsc OcktcrNrbjklzjtlnkja bnjas

Hcmloja/_urbloja Brnup Prjotloc

Ankb tcrh pjrtkcrsdlp wltddnspltja

Banfja onktrjotlkb

_crvloc alkc onkocpt

8/13/2019 The Business of Liver Transplantation

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Alvcr Mlscjsc OcktcrRdy wnuam pjrtkcrs wjkt lt>

_urbcnks alec tn npcrjtc--j ant

Lkpjtlckt jkm Nutpjtlckt pjtlckt ojrc

kccms jrc dlbd jkm brnwlkb Lk HCAM crj kccm tn ojrc inr vcry sloe pjtlckts inr

trjkspajkt prnbrjh tn survlvc

DOO--kccm tn sorcck jkm hjkjbc

Alst hjkjbchckt jkm nutrcjod jrc orltloja

]dcrcs cknubd hnkcy--sdjrc wltdpjrtkcrs knt pnnrcr mlvlslnks lk surbcry

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_urbloja hnmca

2 _urbcnks

: dcpjtnanblst :00 NA]

_urbcnks 1:3 ojscs/yr

Nkay ojk cvjaujtc :0

ojscs/wcce

Alvcr Mlscjsc OcktcrRdy wnuam pjrtkcrs wjkt lt>

Hcmloja Hnmca

? _urbcnks

= dcpjtnanblsts :00 NA]

_urbcnks ;?0ojscs/ycjr

Ojk cvjaujtc ;=0ojscs/wcce

_jvlkbs 8 : I]C +sjajry mliicrcktlja

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Hcmloja jkm _urbloja pjtlckts, knt alhltcm fymljbknsls (c.b. DOO)

Kccm mcmlojtcm tcjh inr onktlkulty ni ojrc jkmcmuojtlnk

Mcmlojtcm uklt lhprnvcs qujalty ni ojrc jkmcmuojtlnk ni pjtlckts jkm ijhlalcs

Dnuscstjii - lmcjaay hcmloja jkm surbloja rcslmckts

PJ/KP JVC kccmcm

Cksurc onhpaljkoc wltd prntnonas jkm oalklojapjtdwjys, cmuojtc dnuscstjii

Mjlay rnukms wltd twn jttckmlkbs

Alvcr Mlscjsc OcktcrLkpjtlckt ojrc

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Gnlkt prjotloc-dcpjtnanby jkm surbcnk

Cjod pjtlckt jsslbkcm tn prlhjry dcpjtnanblst jkmKP/PJ

]rjkspajkt Onnrmlkjtnrs--prcicrjfay KP/PJs Vnutlkc hjkjbchckt ni prc-NA] ojkmlmjtcs jkm Pnstnpcrjtlvc

lhhuknsupprcsslnk

Dcpjtnanby prjotloc jkm rcscjrod pjtlckts

Pjtlckt cmuojtlnk, fntd prc jkm pnst

Oacrloja suppnrt jkm cacotrnklo mjtj csscktlja

_urbcnks pjrtlolpjtc lk cvjas, dcpjtnflaljrysurbcry jkm lhhcmljtc pnst-np pcrlnm

Alvcr Mlscjsc Ocktcr

Nutpjtlckt ojrc

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Onst mrlvck prlhjrlay fy ackbtd nistjy--LOS jkm tntja

Dnspltja onsts jrc ajrbcst onhpnkcktHcmlojtlnk onsts rcajtlvcay onkstjkt

cxocpt inr LY lkiuslnks

Onktrjotlkb inr ]rjkspajktDnw tn cstlhjtc onst

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Jvcrjbc Odjrbc ($)Cvjaujtlnk ::,000Ojkmlmjoy (pcr hnktd) :0,900

Prnourchckt 6=,200Dnspltja (tn mlsodjrbc) :44,

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Alvcr ]rjkspajktjtlnkOnhpnkckts ni onst

Dnspltja

Hcmlojtlnks

Pdysloljk

Ajfs

Nrbjkprnourchck

Dcpjtnanby

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Onst ni Alvcr ]rjkspajktjtlnk

Prc-trjkspajkt ijotnrsVcolplckt Jbc

Mljaysls

Hcodjkloja vcktlajtlnk

Jmvjkocm alvcr mlscjsc, dlbd HCAM

Vctrjkspajktjtlnk

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Prcscrvjtlnk tlhc

_urbloja onhpalojtlnks

OHY lkicotlnk

Vcgcotlnk trcjthckt

Onst ni Alvcr ]rjkspajktjtlnkPcrl-trjkspajkt ijotnrs

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Onktrjotlkb inr ]rjkspajkt

? Pdjscs Pdjsc L--prc-NA]. Ojk scpjrjtc lkltlja cvjaujtlnk

Pdjsc LL--NA] jmhlsslnk +/- ?0-

8/13/2019 The Business of Liver Transplantation

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Cvjaujtlnk Hcmloja

_urbloja

]csts (rjmlnanby, ajfnrjtnry, ojrmljo)

Prc-trjkspajkt hjkjbchckt Hnstay hcmloja ojrc

Dnspltjalzjtlnks inr onhpalojtlnks auorjtlvc inr dnspltja, kntpdysloljks

Yjrljfac fjscm nk wjltlkb tlhc

Ntdcr tdjk mlsonuktcm odjrbcs, mliilouat tn onktrjot inr

Calhlkjtlkb/rcmuolkb tdls pdjsc hjgnr jmvjktjbc ni alvlkbmnkjtlnk

Onktrjotlkb inr ]rjkspajktPdjsc L

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]rjkspajkt Jmhlsslnk _urbcry, jkcstdcslj, rjmlnanby wcaa rclhfurscm

Nitck hnkcy anscr inr hcmlolkc

Dnspltja prnilt hnst hjrecm

Pnst-np ojrc (up tn

8/13/2019 The Business of Liver Transplantation

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Ankb-tcrh pnst-np ojrc fy pdysloljk nrsurbcnk

Kn bnnm rclhfurschckt inr ajf rcvlcw Hnst onst-ciicotlvc strjtcby ls tn alhlt ojrc

tn lhhuknsupprcsslnk jkm trjkspajktrcajtcm ojrc jkm mcicr ntdcr lssucs tn

prlhjry/rcicrrlkb HM Hnrc alhltcm dnspltja prnilt (cxocpt inr

flnpslcs, rcjmhlsslnks)

Onktrjotlkb inr ]rjkspajktPdjsc LLL

8/13/2019 The Business of Liver Transplantation

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Onktrjotlkb inr ]rjkspajktCxjhpac $63 E Prniccs, AN_ 4 mjys

Odjrbcs % Vclhfurschckt

_urbcry $60,000 3=% $:?,300

Dcpjtnanby $:000 6.2 923

Jkcstdcslj $2000 :< =200

Vjmlnanby $=000 :: 6200

Ntdcrs $3000 :3 ??00

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Odjrbcs jkm VYS fjscm jaanojtlnk nionktrjotcm jhnukt wlaa fc lksuiilolckt inrdcpjtnanby

Hjgnrlty wlaa bn tn surbcry, jkcstdcslj jkmrjmlnanby--30 NA] wlaa pjy inr : I]Cjkcstdcslj jkm 0.3 I]C ni dcpjtnanby KP

_nautlnks Gnlkt prjotloc wltd surbcry

Hjkjbchckt icc--~60% (~$3E) rchnvcm irnh rlse pnna

Onktrjotlkb inr ]rjkspajkt_nautlnks

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Conknhlos ni ]rjkspajktjtlnkDnw tn hjec j prnilt

_trjtcby :-Mnkt mn djrm ojscs

_trjtcby 6-Mn djrm ojscs fut mn tdch rlbdt

_dnt scacotlnk-mnknr/rcolplckt hjtodlkb

Kn syhpjtdy trjkspajkts

Hlklhlzc onhpalojtlnks jkm rcgcotlnk

Fcttcr nutonhcs jrc anwcr onst

Eknw ynur onsts jkm mnkt onktrjot jt j anss

Ynauhc wlaa cqujalzc nutalcrs fut li hcjk onst;rclhfurschcktojkknt hjec lt up wltd vnauhc

Fc wjry ni hjrect sdjrc jrbuhckts, ruhnrs jfnut onhpctltlnk

Vlse-fjscm onktrjotlkb

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Vcoajlh prnocmurja rcvckuc

Onhprcdckslvc ojrc alec ojrmlnanby Satrjsnukm--prnfjfay jaa BLs sdnuam mn

]rjksgubuajr flnpslcs jkm prcssurcs Pcroutjkcnus tuhnr tdcrjpy

Ajpjrnsonpy

Prnfjfay kn onanknsonpy, gust CBM +/- CVO, C_N

Fcttcr ojrc jkm hnrc jpprnprljtc mcolslnks

Vcjsnk inr jmmltlnkja ycjr inr OJZ--wlaajttrjot hnrc icaanws

J_DC

]rjkspajkt Dcpjtnanby]dc iuturc

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Dcpjtnanby rcqulrcs jk lktcbrjtcm fuslkcssuklt tdjt rconbklzcs mnwkstrcjh rcvckuc

_urbcry jkm dnspltja jrc kcocssjry fuslkcss

pjrtkcrs--mcalvcr vjauc tn pjrtkcrs Eknw ynur onsts, hjec tdc hnkcy wnre jkm

chfrjoc onaajfnrjtlnk

]dc iuturc wlaa frlkb hnrc prnocmurja

rcvckuc lktn dcpjtnanby Hnttn inr tnhnrrnw -- tdc iuturcs sn frlbdt L

bnttj wcjr sdjmcs--]lhfue?

]rjkspajkt Dcpjtnanby_uhhjry