The challenging triangle: balancing outcomes, transplant numbers and costs.

Transplant centers juggle at least three objectives important to success: transplant volume, outcomes and costs. Improving one frequently occurs at the expense of the others. It may be difficult to have a high-volume program with excellent outcomes and low costs. There are some programs that can do well in all these areas, but even they might be able to improve one of the outcome measures if they would compromise on the one of the others (i.e. a transplant center with good outcomes might be able to achieve even better outcomes if it restricted the patients it was willing to transplant or used only the best organs). It is up to transplant surgeons and physicians to balance all these objectives.