Organ utilization from increased infectious risk donors: An observational study

Area of Science:

• Transplantation immunology
• Infectious disease epidemiology
• Organ procurement and utilization

Background:

• Increased risk donors (IRDs) pose a potential risk for transmitting human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV).
• Organs from IRDs can be safely transplanted with informed recipient consent and appropriate post-transplant monitoring.
• This study reviews the characteristics and organ utilization rates of IRDs within an Organ Procurement Organization (OPO) over a two-year period.

Purpose of the Study:

• To evaluate the characteristics of increased risk donors (IRDs).
• To determine the organ utilization rates for IRDs.
• To assess the impact of pre-transplant nucleic acid testing (NAT) on IRD organ utilization.

Main Methods:

• Donor data from April 1, 2013, to March 31, 2015, were collected from the OPO database.
• Only consented donors were included in the analysis.
• Donors were classified as IRDs based on Health Canada/Canadian Standards Association (CSA) criteria.

Main Results:

• Out of 494 potential donors, 92 (18.6%) were identified as IRDs.
• Organs were transplanted from 76 (82.6%) of the IRDs.
• Common risk factors included injection drug use (12%), men who have sex with men (7%), commercial sex work (4%), and incarceration (24%).
• Fifty-nine percent of IRD organs were utilized, with kidneys and livers being the most frequently transplanted.
• Pre-transplant NAT was performed on 18.5% of IRDs, and organ utilization rates were similar between donors with and without NAT (94% vs. 80%, P=.29).

Conclusions:

• Increased risk donors (IRDs) represent a substantial portion of potential organ donors.
• IRD organs are utilized at a significant rate, even without pre-transplant nucleic acid testing (NAT).
• These findings suggest that perceptions of infectious risk associated with IRD organs are influenced by multiple factors beyond NAT results.