Utilization of organs following implementation of the 2020 United States Public Health Service guideline...

Area of Science:

• Transplantation immunology
• Infectious disease epidemiology
• Public health policy

Background:

• The 2013 U.S. Public Health Service (PHS) guideline identified increased risk donors (IRDs) based on social/behavioral factors linked to HIV, HBV, and HCV transmission.
• This designation led to underutilization of IRD organs, potentially limiting transplant options.
• In 2020, PHS updated guidelines removed the IRD designation and specific risk criteria.

Purpose of the Study:

• To evaluate the impact of the 2020 PHS guideline revision on organ utilization.
• To compare organ utilization rates between donors with and without risk factors post-guideline update.

Main Methods:

• Analysis of adult and pediatric organ transplantation data from 2019 to 2023.
• Logistic regression modeling to determine adjusted organ utilization rates.
• Sensitivity analysis for pediatric kidney transplant utilization.

Main Results:

• No statistically significant differences in organ utilization were observed between donors with risk factors and standard risk donors after the 2020 PHS guideline update.
• An exception was noted in one subgroup of pediatric kidney transplants.
• Utilization of organs from donors with risk factors for HIV, HCV, and HBV became comparable to standard risk donors, contrasting with earlier underutilization findings.

Conclusions:

• The 2020 PHS guideline revision effectively eliminated the underutilization of organs from donors with social and behavioral risk factors for HIV, HBV, and HCV.
• Updated guidelines promote equitable organ utilization, increasing the availability of organs for transplantation.
• The policy change supports broader access to life-saving transplants without compromising safety.