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Utilization of deceased organ donors based on HIV, hepatitis B virus, and hepatitis C virus screening test results
Nicole Theodoropoulos1, Aimee Kroll-Desrosiers2, Michael G Ison3,4,5
1Division of Infectious Diseases & Immunology, Department of Medicine, University of Massachusetts, Worcester, Massachusetts.
Insights
Nucleic acid tests (NATs) for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) in deceased organ donors increased organ utilization. NATs detected infections in seronegative donors, improving donor pool access.
Area of Science:
- Transplantation immunology
- Infectious disease screening
- Public health
Background:
- Deceased organ donors are screened for HIV, HBV, and HCV using serologic and nucleic acid tests (NATs).
- The impact of these screening results on donor organ utilization has not been previously quantified.
Purpose of the Study:
- To evaluate the association between infectious disease screening results (HIV, HBV, HCV) and the utilization of deceased organ donors.
- To assess the role of NATs in enhancing donor organ utilization.
Main Methods:
- Data from 38,166 potential deceased organ donors across 26 organ procurement organizations (OPOs) from 2004-2017 were analyzed.
- Primary HIV, HBV, and HCV screening results and organ utilization data were collected.
- Logistic regression was used to analyze the relationship between test results and organ utilization.
Main Results:
- A small percentage of donors tested positive for antibodies but negative for NATs (HIV: 0.1%, HBV: 5.2%, HCV: 1.8%).
- Organ utilization for donors who were NAT-negative despite positive antibody status (HBV/HCV) increased over the study period.
- NAT screening identified infections in seronegative donors, particularly for HCV.
Conclusions:
- NATs are crucial for detecting infections in seronegative deceased organ donors, especially for HCV.
- Implementing NAT for deceased donor screening is associated with increased organ utilization, expanding the donor pool.
Background:
Potential deceased organ donors are screened for human immunodeficiency virus (HIV-1), hepatitis B virus (HBV), and hepatitis C virus (HCV) with serologic tests and nucleic acid tests (NATs). The results of these tests on the utilization of donors have not been directly measured.
Methods:
Twenty-six organ procurement organizations (OPOs) provided primary HIV, HBV, and HCV screening results and utilization information for donor referrals evaluated from 2004 to 2017. Additional information regarding donor organ utilization was obtained from the Organ Procurement and Transplantation Network database. Data were analyzed using logistic regression.
Results:
Test results were submitted for 38 166 potential deceased organ donors; 31 (0.1%) were HIV NAT-negative but seropositive, 5.2% were HBV core antibody-positive and NAT-negative, while 1.8% were HCV antibody-positive and NAT-negative. Organ utilization of HBV and/or HCV NAT-negative organs increased over time despite positive antibody status.
Conclusions:
Nucleic acid test detected infections in seronegative donors, especially for HCV. The use of NAT for deceased donor screening correlated with increased utilization of donor organs.
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