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Viral nucleic acid testing (NAT) and OPO-level disposition of high-risk donor organs
L M Kucirka1, C Alexander, R Namuyinga
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
High-risk donor organs pose risks, but nucleic acid testing (NAT) can reduce infectious disease transmission. Practices vary widely among organ procurement organizations, suggesting a need for national policy on NAT for organ donation.
Area of Science:
- Transplantation immunology
- Infectious disease epidemiology
- Public health policy
Background:
- Use of high-risk donor (HRD) organs is controversial due to infectious disease transmission risks, including HIV and HCV.
- Nucleic acid testing (NAT) shortens the window period for detecting infections, thereby reducing transmission risk.
- Variability in organ procurement organization (OPO) practices regarding NAT may impact organ utilization.
Purpose of the Study:
- To characterize HRDs and organ disposition by OPO.
- To measure NAT practices across OPOs.
- To examine associations between NAT practices and HRD organ utilization.
Main Methods:
- Analysis of deceased donor data (including HRDs) from UNOS (July 2004–May 2008).
- Survey of OPO clinical directors on NAT utilization, turnaround times, and result availability.
- Statistical examination of associations between NAT practices and OPO characteristics/organ export.
Main Results:
- Significant variation exists in NAT performance: 51.7% of OPOs always perform HIV NAT, 24.1% never do; similar patterns for HCV NAT.
- The majority of OPOs (65.6%) never perform Hepatitis B virus (HBV) NAT.
- OPOs performing HIV NAT are less likely to export organs, and AIDS prevalence does not correlate with NAT practice.
Conclusions:
- Wide variation in current NAT practices among OPOs necessitates a review.
- Standardized NAT protocols could potentially improve organ utilization and reduce infectious risks.
- Consideration of a national policy for NAT in organ donation is supported by findings.
Abstract:
The use of Public Health Service/Centers for Disease Control and Prevention (PHS/CDC) high-risk donor (HRD) organs remains controversial, especially in light of a recent high-profile case of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission. Nucleic acid testing (NAT), while more expensive and time consuming, reduces infectious risk by shortening the period between infection and detectability. The purpose of this study was to characterize HRDs and disposition of their organs by organ procurement organization (OPO), to measure NAT practices by OPO and to examine associations between NAT practices and use of HRD organs. We analyzed 29 950 deceased donors (2574 HRDs) reported to UNOS since July 1, 2004 and May 8, 2008. We then surveyed all OPO clinical directors about their use of NAT, average time to receive NAT results, locations where NAT is performed and percentage of the time NAT results are available for allocation decisions. In total, 51.7% of OPOs always perform HIV NAT, while 24.1% never do. A similar pattern is seen for HCV NAT performance, while the majority (65.6%) never perform HBV NAT. AIDS prevalence in an OPO service area is not associated with NAT practice. OPOs that perform HIV NAT are less likely to export organs outside of their region. The wide variation of current practice and the possibility that NAT would improve organ utilization support consideration for a national policy.
