Characteristics and Donation Outcomes of Potential Organ Donors Perceived to Be at Increased Risk for Blood-borne Virus Transmission: An Australian Cohort Study 2010–2018

Waller, Karen; Mata, Nicole De La; Rosales, Brenda; Hedley, James; Kelly, Patrick J.; Thomson, Imogen K.; O’Leary, Michael J.; Cavazzoni, Elena; Ramachandran, Vidiya; Rawlinson, William D.; Wyburn, Kate; Webster, Angela C

doi:10.1097/tp.0000000000003715

Cited by 4 publications

(9 citation statements)

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“…Whilst not consistent with national guidelines, some potential organ donors are rejected prior to commencement of formal donation workup, either through self-censoring by the referring clinician, or based on cursory assessment by a donation service. The later having previously been documented within the local context ( 14 ). This may reduce the assessed predictive power or IRBs.…”

Section: Discussionmentioning

confidence: 89%

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Prevalence of Blood-Borne Viruses and Predictors of Risk in Potential Organ Donors in Australia

Dutch

Patrick²,

Boan

et al. 2022

Transpl Int

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Internationally, the designation of a patient as an increased viral risk organ donor has been associated with lower utilisation rates. The actual prevalence of blood borne viruses in Australian potential organ donors, and the predictive performance of questionnaires administered to stratify this risk, remains unknown. We conducted a retrospective review of all patients who commenced workup for donation on the national database between 2014–2020. The prevalence of HIV, Active HBV and Active HCV in 3650 potential organ donors was 0.16%, 0.9%, and 2.2%, respectively. The behavioural risk profile was assessed in a subset of 3633 patients. Next-of-kin reported increased risk behaviours were associated with an increased prevalence of HCV but not of HIV or HBV (OR 13.8, p < 0.01, OR 0.3. p = 0.42, OR 1.5, p = 0.14). Furthermore, the majority of HIV and HBV infections occurred in potential donors without a disclosed history of increased risk behaviours. In this series, donors had a higher prevalence of HCV, and similar rates of HBV and HIV to the broader community. Behavioural transmission risks were poorly predictive of HIV and HBV. Rather than pre-transplantation behavioural risk screening, routine post-transplant recipient screening may provide a more powerful tool in mitigating the consequences of unexpected viral transmission.

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Section: Discussionmentioning

confidence: 89%

“…A recent study, from New South Wales, Australia, highlighted that a significant portion of potential donors did not proceed to donation, based solely on the presence of increased risk behaviours ( 14 ). In some instances, the decision not to progress with donation workup occurred prior to pathology screening.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Blood-Borne Viruses and Predictors of Risk in Potential Organ Donors in Australia

Dutch

Patrick²,

Boan

et al. 2022

Transpl Int

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“…We used the estimate of a 7% increase in the donation rate in the largest state of New South Wales, Australia, when potential donors who were rejected because of BBV transmission but are now been medically accepted, achieved consent at the current rate of 61%, based on Australian donation and transplantation activity. 12,51 In 2018, there were 897 kidney transplants from 554 deceased organ donors. 51 The 7% increase in donation rate based on the estimate of 1 state could add 39 more donors with increased risk behaviors.…”

Section: Discussionmentioning

confidence: 99%

“…The rate of transplantation was assumed to be 7% (5% from HCV donors; 2% from increased risk behavior donors) higher for the new strategy than the current practice due to the availability of additional kidneys from donors with increased risk behaviors and HCV (Table 1). 12…”

Section: Modeling Patient Experience While On the Kidney Waitlistmentioning

confidence: 99%

“…11 However, many such donors have been declined without formal BBV testing, despite otherwise favorable donor characteristics. 12 Meanwhile, testing and treatment have evolved, reducing the risk of harm to recipients, yet current clinical practice remains inconsistent despite changed guidelines. 5 In the European Union, nonstandard risk donors defined as those with potential risk of BBV infections, multidrug-resistant bacterial infections, or malignant disease associated with clinical or behavioral risk factors have not been uniformly considered for donation.…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of Kidney Transplantation From Donors at Increased Risk of Blood-borne Virus Infection Transmission

et al. 2023

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Background. Demand for donor kidneys outstrips supply. Using kidneys from selected donors with an increased risk of blood-borne virus (BBV) transmission (hepatitis B virus and hepatitis C virus [HCV], human immunodeficiency virus) may expand the donor pool, but cost-effectiveness of this strategy is uncertain. Methods. A Markov model was developed using real-world evidence to compare healthcare costs and quality-adjusted life years (QALYs) of accepting kidneys from deceased donors with potential increased risk of BBV transmission, because of increased risk behaviors and/or history of HCV, versus declining these kidneys. Model simulations were run over a 20-y time horizon. Parameter uncertainty was assessed through deterministic and probabilistic sensitivity analyses. Results. Accepting kidneys from donors at increased risk of BBVs (2% from donors with increased-risk behaviors and 5% from donors with active or past HCV infection) incurred total costs of 311 303 Australian dollars with a gain of 8.53 QALYs. Foregoing kidneys from these donors incurred total costs of $330 517 and a gain of 8.44 QALYs. A cost-saving of $19 214 and additional 0.09 QALYs (~33 d in full health) per person would be generated compared with declining these donors. Increasing the availability of kidneys with increased risk by 15% led to further cost-savings of $57 425 and additional 0.23 QALY gains (~84 d in full health). Probabilistic sensitivity analysis using 10 000 iterations showed accepting kidneys from donors at increased risk led to lower costs and higher QALY gains. Conclusions. Shifting clinical practice to accept increased BBV risk donors would likely produce lower costs and higher QALYs for health systems.

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Successful Implementation of an Increased Viral Risk Donor Waiting List for Preconsented Kidney Transplant Candidates in Victoria, Australia

Lee

Gramnea

Seng

et al. 2021

Transplantation Direct

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T he number of people awaiting deceased donor kidney transplantation continues to exceed the availability of kidneys worldwide. Organs from increased viral risk donors (IVRDs) with increased risk behaviors for blood-borne virus (BBV) infection have historically been under-utilized. With the introduction of universal prospective nucleic acid testing (NAT) for IVRDs, the risk of "window period" infection Kidney TransplantationBackground. Increased viral risk donors (IVRDs) with increased risk behaviors for blood-borne virus infection and negative nucleic acid testing have a low absolute risk of "window period" infection. Utilization and allocation of IVRD organs differ between jurisdictions. Methods. We examined the characteristics and utilization of deceased donor IVRD kidneys and recipient outcomes within a 2-y period (July 31, 2018-July 31, 2020) postimplementation of a new opt-in allocation pathway for preconsented recipients in Victoria, Australia. Results. Fifty-six kidneys from 31 IVRDs were utilized, comprising 13% of donors. Preconsent rate to accept IVRD kidneys increased to 41% of the waitlist in the 2 y postimplementation, and IVRDs having no kidneys utilized reduced to 0%. Compared with non-IVRD kidneys, kidney offer declines >10 per donor were less likely from IVRDs (3% vs 19%; P < 0.05). IVRDs were younger (median age 36 vs 51 [35-60] y; P < 0.0001), with lower kidney donor profile index (25% [13-40%] vs 57% [29-75%]; P < 0.0001), and less hypertension (0% vs 22%; P < 0.01). Estimated glomerular filtration rate 3 mo post-transplant was superior (P < 0.01). Injecting drug use (61%) was the most common increased risk behavior. 29% of IVRDs were hepatitis C antibody positive but nucleic acid testing negative. No active infection was detected in any recipient post-transplant. Conclusions. The described opt-in system permits efficient allocation and utilization of kidneys from IVRDs, with superior quality and graft function. Education is crucial to facilitate informed consent and equity of access to this donor pool.

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Characteristics and Donation Outcomes of Potential Organ Donors Perceived to Be at Increased Risk for Blood-borne Virus Transmission: An Australian Cohort Study 2010–2018

Abstract: Supplemental Digital Content is available in the text.

Cited by 4 publications

References 25 publications

Prevalence of Blood-Borne Viruses and Predictors of Risk in Potential Organ Donors in Australia

Prevalence of Blood-Borne Viruses and Predictors of Risk in Potential Organ Donors in Australia

Cost-effectiveness of Kidney Transplantation From Donors at Increased Risk of Blood-borne Virus Infection Transmission

Successful Implementation of an Increased Viral Risk Donor Waiting List for Preconsented Kidney Transplant Candidates in Victoria, Australia

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