Unusually complex and expensive, organ transplantation is perhaps the most intensely regulated of medical disciplines. The extensive system of financial tracking and reimbursement for organ transplants reflects this complexity. Unfortunately, the surgeons and physicians most directly involved in evaluating and caring for transplant patients and donors are often largely unaware of how—or even whether—compensation occurs for their services.

Although a hospital "owns" and is responsible for administration of a transplant program, it is the medical director appointed for each transplanted organ who plans, organizes, and leads the extensive staff in executing the transplant center's activities. Transplant surgeons and physicians must understand the rules and accounting practices peculiar to transplantation so they can work effectively with their medical directors and to optimize reimbursement for their services.

Without knowledge and advocacy of the fiscal issues surrounding organ transplantation, the fiscal health of a seemingly robust transplant program may be undermined. In contrast, when the hospital and its physicians and surgeons are equally concerned about the other's fiscal integrity, transplant centers can thrive and better provide high-quality organ transplant services.

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