Trends in Increased Infection Risk Deceased Organ Donors. A Two-Centre Retrospective Study

Canadian regulatory standards require the label increased risk donor (IRD) be applied to donors with risk factors for hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus infection (HIV). This study aimed to assess trends in the rate of IRD and specific donor risk factors over time as well as the association with donor screening results for HBV, HCV and HIV.

This was a retrospective study of deceased organ donors at 2 Canadian centers (University of Alberta Hospital and Transplant Manitoba) encompassing an overlapping period between 2013 and 2022. The proportion of IRD donations over time were analyzed with trend analysis. Trends for risk factors and their association with donor screening results were explored.

Overall, 332 of 1491 (22.3%) donors were categorized as IRD. A significant rising trend of IRD donors was documented for Alberta. Any donor drug use and overdose as cause of death increased during the study period and were strongly associated with HCV infection (OR 18.03 (6.34-51.2) p<0.001 and OR 6.48 (3.32-12.65) p<0.001). Donors classified as men who had sex with men (MSM) did not have an increased risk of HBV, HCV or HIV. Answers to some questions on the donor risk history were "I don't know" in up to 20% of specific questionnaire items.

Our study demonstrates a rising proportion of IRD organ donations in 2 Canadian transplant centers. The regulatory requirements include variables not associated with HBV/HCV/HIV and do not capture others associated with risk in this cohort. The proportion of "I don't know" responses on the donor risk assessment highlights its limitations. This data may inform donor risk assessment in the Canadian setting and highlights the changing epidemiology of HBV/HCV/HIV in organ donors.