Lung transplant recipient attitudes and beliefs on accepting an organ that is positive for hepatitis C virus

Abstract

Introduction:Little is known about patient perceptions regarding HCV+ organ use in non-HCV-infected recipients. This study examined factors influencing the decision to accept HCV+ organs and the resulting impacts.Methods: Adult lung transplant (LT) patients or candidates who had consented to receive an HCV+ organ completed a survey including multiple choice, a five-point Likert scale, and free-text answers. A total of 67 LT recipients or candidates who had consented to receive HCV+ organs were enrolled, of which 21/67 (31%) received HCV+ lungs, 39 (58%) HCV− lungs, and seven (10%) were still waiting.Results: Pre-transplant, 50/67 (75%) patients felt it was either "completely safe" or "very safe" to accept an HCV+ organ. Although 22/67 (33%) said they never or rarely took risks, they still made the decision to accept an HCV+ organ. Common reported reasons were desperation, perception of having "no choice," and increasing symptom severity. In the subset of patients that were transplanted with an HCV+ organ (n = 21), only 12.5% reported second thoughts about accepting. Post-transplant, the majority (87.5%) never felt any anxiety about HCV and most (83%) reported no impact from HCV. Perception of treatment tolerability and ease was highly favorable. Conclusion:Use of HCV+ organs demonstrated minimal detrimental perceived impacts on lung transplant patients. Patients generally found the experience to be very positive.

Clinician and patient attitudes toward use of organs from hepatitis C viremic donors and their impact on acceptance: A contemporary review

“…Other studies 9,12 similarly identified that older age was associated with willingness to accept a viremic kidney, although the reasons for this trend were not explored. A final study examining lung transplant candidates showed an extreme lack of concern about curability, with 76.2% of patients not concerned about lack of efficacy and the remaining 23.8% finding themselves neutral 15 . However, it appeared that the patients had high belief in the potential for cure, rather than apathy towards the prospect of cure; and 45.8% noted that the risks of persistent HCV appeared lower than the risk of dying without lung transplantation 15 …”

“…15 However, it appeared that the patients had high belief in the potential for cure, rather than apathy towards the prospect of cure; and 45.8% noted that the risks of persistent HCV appeared lower than the risk of dying without lung transplantation. 15…”

“…21 The incidence of sexual transmission within stable monogamous relationships is thought to be as low as 0-.6% per year. 22 Patients were largely unconcerned about the risk of transmission prior to transplant: only one study identified pretransplant transmission-related anxiety, 15 and only 9% of those patients expressed apprehension. However, among patients who received an HCV-positive transplant, concerns surfaced 13,14 ; approximately 36% of patients who received viremic donors reported fear of transmission to partners, family, or friends, 13 and 23% reported significantly modifying behavior after transplant to abrogate risks of transmission.…”

“…However, among patients who received an HCV-positive transplant, concerns surfaced 13,14 ; approximately 36% of patients who received viremic donors reported fear of transmission to partners, family, or friends, 13 and 23% reported significantly modifying behavior after transplant to abrogate risks of transmission. 15 Additionally, some patients reported that they wanted more pretransplant education on the risks of transmission. 13 Similarly, 30% of providers mention concern for viral transmission to household members of patients.…”

“…The impact of trust in healthcare providers on acceptance of viremic organs is controversial within these studies. Couri et al and Humar et al reported that higher physician trust was associated with increased willingness to accept NAT positive organs 9,15 ; however, McCauley et al found that patients were more likely to decline if they had higher trust in physicians. 12 The latter author conjectured that the trust evaluated was in the patient's primary doctor, rather than transplant physicians, and indicated that the patients were likely receiving conflicting information from other non-transplant professionals that caused them to be less amenable.…”