Expanding deceased donor kidney transplantation: medical risk, infectious risk, hepatitis C virus, and HIV

Area of Science:

• Transplant medicine
• Organ transplantation
• Infectious disease in transplantation

Background:

• Severe organ shortage in the US affects over 90,000 individuals awaiting transplants.
• Traditional organ acceptance criteria exclude many potentially viable donor organs.
• Dialysis poses significant risks for patients awaiting kidney transplants.

Purpose of the Study:

• To reevaluate the utility of previously discarded donor organs for transplantation.
• To assess the survival benefit of using organs from increased-risk donors for waitlisted candidates.
• To explore the impact of new medical advancements and legislation on organ utilization.

Main Methods:

• Review of outcomes for transplant candidates receiving organs from increased-risk donors (e.g., high Kidney Donor Profile Index, HCV+, HIV+).
• Analysis of prospective trials involving transplantation of HCV-infected donor organs into HCV-negative recipients.
• Consideration of legislative changes, such as the HIV Organ Policy Equity Act, enabling HIV-positive to HIV-positive transplants.

Main Results:

• Organs from increased-risk donors offer a survival benefit compared to remaining on dialysis.
• Direct-acting antivirals have enabled successful transplantation of HCV-infected donor organs.
• The HIV Organ Policy Equity Act permits transplants from HIV-positive deceased donors to HIV-positive recipients.

Conclusions:

• Increased utilization of previously discarded donor organs enhances deceased donor transplant numbers.
• More transplant candidates are receiving life-saving treatment due to expanded organ acceptance criteria.
• Revisiting organ acceptance criteria is crucial for addressing the organ shortage and improving patient survival.