Deceased Organ Donors and PHS Risk Identification: Impact on Organ Usage and Outcomes

Area of Science:

• Transplantation immunology
• Public health policy
• Infectious disease transmission

Background:

• In 2013, Public Health Service (PHS) criteria changed to identify organ donors at increased risk for HIV, HBV, and HCV.
• The impact of this change on donor demographics, organ utilization, and patient outcomes was previously unknown.

Purpose of the Study:

• To evaluate the effects of the 2013 PHS donor designation policy on organ utilization and transplant outcomes.
• To assess the risk of HIV, HBV, and HCV transmission associated with PHS-designated donors.

Main Methods:

• A retrospective review of the Organ Procurement and Transplantation Network (OPTN) database.
• Analysis of organ donor demographics, organ utilization rates, and patient/graft survival.
• Comparison between PHS-designated and standard-risk deceased organ donors.

Main Results:

• Over 20% of US deceased organ donors were classified as PHS increased risk post-2013.
• PHS donors were younger, more likely male, and had different risk factors than standard donors.
• Organs from younger PHS donors (18-34 years) tested negative for HCV were transplanted less frequently.
• Patient and graft survival rates were equivalent, and HIV, HBV, HCV transmission risks were similar regardless of PHS donor status.

Conclusions:

• The PHS donor designation criteria negatively impact the utilization of high-quality organs.
• There is no demonstrated benefit in identifying a subset of organs with increased transmission risk for HIV, HBV, or HCV.
• Reevaluation of the PHS donor designation rationale is warranted.