Related Experiment Video
Updated: Sep 2, 2025
Heterotopic Auxiliary Whole Liver Rat Transplant Model Utilizing a Hepaticoureterostomy for Allograft Rejection Studies
Published on: March 8, 2024
Decision-making Among Hepatitis C Virus-negative Transplant Candidates Offered Organs from Donors with HCV Infection
M Elle Saine1,2, Erin M Schnellinger1, Michel Liu3
1Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Insights
Patients deciding on organ transplants from hepatitis C virus (HCV)-viremic donors utilize positivist, risk analysis, or instinctual approaches. Many patients combine multiple decision-making strategies when considering HCV-viremic organ transplantation.
Area of Science:
- Transplantation medicine
- Infectious disease research
- Patient decision-making
Background:
- Historically, organs from hepatitis C virus (HCV)-infected donors were discarded.
- Direct-acting antiviral (DAA) therapies enable transplantation of HCV-viremic organs into HCV-negative recipients.
- Factors influencing patient acceptance of HCV-viremic organs are not well understood.
Purpose of the Study:
- To explore patient perceptions and decision-making influences for accepting organs from HCV-viremic donors.
- To understand patient experiences within clinical trials involving HCV-viremic organ transplantation.
- To identify key factors informing candidate choices in HCV-viremic organ acceptance.
Main Methods:
- Qualitative semistructured interview study.
- Embedded within 3 clinical trials on HCV-viremic organ transplantation (lungs and kidneys).
- Study conducted from June 2019 to March 2021 with 44 HCV-negative patients.
Main Results:
- Three primary decision-making approaches identified: positivist, risk analyses, and instinctual response.
- Perceptions of risk significantly influenced decision-making processes.
- Most participants employed multiple decision-making approaches, simultaneously or sequentially.
Conclusions:
- Understanding patient decisional models is crucial for shared decision-making in HCV-viremic organ transplantation.
- Patient perspectives can inform strategies to improve acceptance of HCV-viremic organs.
- This research highlights the complexity of patient choices regarding HCV-viremic organ acceptance.
Background:
Historically, many organs from deceased donors with hepatitis C virus (HCV) were discarded. The advent of highly curative direct-acting antiviral (DAA) therapies motivated transplant centers to conduct trials of transplanting HCV-viremic organs (nucleic acid amplification test positive) into HCV-negative recipients, followed by DAA treatment. However, the factors that influence candidates' decisions regarding acceptance of transplant with HCV-viremic organs are not well understood.
Methods:
To explore patient-level perceptions, influences, and experiences that inform candidate decision-making regarding transplant with organs from HCV-viremic donors, we conducted a qualitative semistructured interview study embedded within 3 clinical trials investigating the safety and efficacy of transplanting lungs and kidneys from HCV-viremic donors into HCV-negative recipients. The study was conducted from June 2019 to March 2021.
Results:
Among 44 HCV-negative patients listed for organ transplant who were approached for enrollment in the applicable clinical trial, 3 approaches to decision-making emerged: positivist, risk analyses, and instinctual response. Perceptions of risk contributed to conceptualizations of factors influencing decisions. Moreover, most participants relied on multiple decision-making approaches, either simultaneously or sequentially.
Conclusions:
Understanding how different decisional models influence patients' choices regarding transplant with organs from HCV-viremic donors may promote shared decision-making among transplant patients and providers.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
01:26Kidney Transplant II: Surgical Procedure