Characteristics of Deceased Solid Organ Donors and Screening Results for Hepatitis B, C, and Human Immunodeficiency Viruses — United States, 2010–2017

Abara, Winston E.; Collier, Melissa G.; Moorman, Anne C.; Bixler, Danae; Jones, Jefferson M.; Annambhotla, Pallavi; Bowman, James S.; Levi, Marilyn E.; Brooks, John T.; Basavaraju, Sridhar V.

doi:10.15585/mmwr.mm6803a2

Cited by 45 publications

(34 citation statements)

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“…The "increased risk donor" terminology might result in patient or provider apprehension regarding organ quality or the risk for disease transmission (26,27). Potential underuse of IRD organs is concerning because a growing number and proportion of organ donors are designated as IRDs as a result of the national opioid epidemic (19,28).…”

Section: Introduction Backgroundmentioning

confidence: 99%

“…Because organ procurement organizations (OPOs) have universally implemented screening of organ donors for HIV, HBV, and HCV infections by NAT since 2017, the 12-month time frame should be shortened (29,30). • All recipients should be screened for HIV, HBV, and HCV infections after transplantation, including recipients of organs from donors without recognized risk factors, because the number and proportion of organ donors with risk factors have increased (28), effective suppression of HIV and hepatitis B and a cure for HCV infection are available to recipients should they become infected (31)(32)(33), and questionnaire responses provided by donors' next of kin regarding risk factors can be inaccurate (34). To address these issues and further assess the impact of the 2013 PHS guideline recommendations on organ use, allocation, and recipient outcomes, CDC conducted additional analyses (28,(34)(35)(36).…”

Section: Introduction Backgroundmentioning

confidence: 99%

“…To address these issues and further assess the impact of the 2013 PHS guideline recommendations on organ use, allocation, and recipient outcomes, CDC conducted additional analyses (28,(34)(35)(36). One study determined that the percentage of adult donors classified as an IRD increased from 9.3% in 2010 to 26.2% in 2017 (28). Among IRDs, 16% had detectable HCV RNA in the blood, compared with 1% among donors without increased risk (28).…”

Section: Introduction Backgroundmentioning

confidence: 99%

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Assessing Solid Organ Donors and Monitoring Transplant Recipients for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infection — U.S. Public Health Service Guideline, 2020

Jones¹,

Kracalik²,

Levi³

et al. 2020

MMWR Recomm. Rep.

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Summary The recommendations in this report supersede the U.S Public Health Service (PHS) guideline recommendations for reducing transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) through organ transplantation ( Seem DL, Lee I, Umscheid CA, Kuehnert MJ. PHS guideline for reducing human immunodeficiency virus, hepatitis B virus, and hepatitis C virus transmission through organ transplantation. Public Health Rep 2013;128:247–343 ), hereafter referred to as the 2013 PHS guideline. PHS evaluated and revised the 2013 PHS guideline because of several advances in solid organ transplantation, including universal implementation of nucleic acid testing of solid organ donors for HIV, HBV, and HCV; improved understanding of risk factors for undetected organ donor infection with these viruses; and the availability of highly effective treatments for infection with these viruses. PHS solicited feedback from its relevant agencies, subject-matter experts, additional stakeholders, and the public to develop revised guideline recommendations for identification of risk factors for these infections among solid organ donors, implementation of laboratory screening of solid organ donors, and monitoring of solid organ transplant recipients. Recommendations that have changed since the 2013 PHS guideline include updated criteria for identifying donors at risk for undetected donor HIV, HBV, or HCV infection; the removal of any specific term to characterize donors with HIV, HBV, or HCV infection risk factors; universal organ donor HIV, HBV, and HCV nucleic acid testing; and universal posttransplant monitoring of transplant recipients for HIV, HBV, and HCV infections. The recommendations are to be used by organ procurement organization and transplant programs and are intended to apply only to solid organ donors and recipients and not to donors or recipients of other medical products of human origin (e.g., blood products, tissues, corneas, and breast milk). The recommendations pertain to transplantation of solid organs procured from donors without laboratory evidence of HIV, HBV, or HCV infection. Additional considerations when transplanting solid organs procured from donors with laboratory evidence of HCV infection are included but are not required to be incorporated into Organ Procurement and Transplantation Network policy. Transplant centers that transplant organs from HCV-positive donors should develop protocols for obtaining informed consent, testing and treating recipients for HCV, ensuring reimbursement, and reporting new infections to public health authorities.

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Section: Introduction Backgroundmentioning

confidence: 99%

Section: Introduction Backgroundmentioning

confidence: 99%

Section: Introduction Backgroundmentioning

confidence: 99%

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Assessing Solid Organ Donors and Monitoring Transplant Recipients for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infection — U.S. Public Health Service Guideline, 2020

Jones¹,

Kracalik²,

Levi³

et al. 2020

MMWR Recomm. Rep.

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“…Opioid use is increasing among Caucasians with even higher rates in the Midwestern United States. Heroin use went up fivefold from 2002 to 2013, coinciding with a surge in intravenous drug use (IVDU), hepatitis C virus (HCV) transmission, and opioid‐related overdose deaths . Donors dying due to overdose are more likely to be infected with HCV, and organs from HCV‐positive donors are underutilized .…”

Section: Introductionmentioning

confidence: 99%

“…Heroin use went up fivefold from 2002 to 2013, coinciding with a surge in intravenous drug use (IVDU), hepatitis C virus (HCV) transmission, and opioid‐related overdose deaths . Donors dying due to overdose are more likely to be infected with HCV, and organs from HCV‐positive donors are underutilized . Single‐center studies have utilized HCV antibody positive and viremic donors for RT with good short‐term outcomes.…”

Section: Introductionmentioning

confidence: 99%

Trends in utilization of deceased donor kidneys based on hepatitis C virus status and impact of public health service labeling on discard

Ariyamuthu

Sandikçi

AbdulRahim

et al. 2019

Transplant Infectious Dis

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Background Kidneys from deceased donors infected with hepatitis C virus (HCV) are underutilized. Most HCV virus‐infected donors are designated as Public Health Service increased donors (PHS‐IR). Impact of PHS and HCV designations on discard is not well studied. Methods We queried the UNOS data set for all deceased donor kidneys between January 2015 and December 2018. The final study cohort donors (n = 38 702) were stratified into three groups based on HCV antibody (Ab) and NAT status: (a) Ab−/NAT− (n = 35 861); (b) Ab+/NAT− (n = 973); and (c) Ab±/NAT+ (n = 1868). We analyzed utilization/discard rates of these organs, the impact of PHS‐IR and HCV designations on discard using multivariable two‐level hierarchical logistic regression models, forecasted number of HCV viremic donors/kidneys by 2023. Results During the study period, (a) the number of viremic donor kidneys increased 2 folds; (b) the multilevel mixed‐effects logistic regression models showed that, overall, the PHS labeling (OR 1.20, CI 95% CI 1.15‐1.29) and HCV designation (OR 2.29; 95% CI 2.15‐2.43) were independently associated with increased risk of discard; (c) contrary to the general perception, PHS‐IR kidneys across all HCV groups, compared to PHS‐IR kidneys were more likely to be discarded; (d) we forecasted that the number of kidneys from HCV viremic donor kidneys might increase from 1376 in 2019 to 2092 in 2023. Conclusion Hepatitis C virus viremic kidneys might represent 10%‐15% of deceased donor organ pool soon with the current rate of the opioid epidemic. PHS labeling effect on discard requires further discussion of the utility of this classification.

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Hepatitis B and Hepatitis D Infections in the Transplant Setting

Kim

Terrault

2020

Emerging Transplant Infections

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Characteristics of Deceased Solid Organ Donors and Screening Results for Hepatitis B, C, and Human Immunodeficiency Viruses — United States, 2010–2017

Cited by 45 publications

References 10 publications

Assessing Solid Organ Donors and Monitoring Transplant Recipients for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infection — U.S. Public Health Service Guideline, 2020

Assessing Solid Organ Donors and Monitoring Transplant Recipients for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infection — U.S. Public Health Service Guideline, 2020

Trends in utilization of deceased donor kidneys based on hepatitis C virus status and impact of public health service labeling on discard

Hepatitis B and Hepatitis D Infections in the Transplant Setting

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