The Future of Hepatitis C-Positive Organ Transplants
For people waiting for life-saving organ transplants, receiving a healthy organ is never a guarantee. More than 100,000 patients are on organ donation lists in the US, but only about one-third typically receive the donation needed to save their lives.1 Because of this, researchers and health professionals are working hard to discover ways to increase the amount of healthy organs available for donation.
In the past, organs from hepatitis C virus (HCV)-positive patients were not offered to patients needing organ donation, or they were only offered to already HCV-positive patients.2 But could HCV-positive organs be safely used in patients who do not have hep C?
Barriers to HCV-positive organ donation
With hepatitis C, chronic infection can continue and progress for up to 20 years or longer without symptoms. Usually when symptoms appear, the organs are often too damaged for transplant.3 In these cases, patients with progressed disease may have chosen to be organ donors, but were unaware of disease damage. In addition, many HCV-positive donor organs are from deaths caused by drug overdose, which do not meet the standard criteria for donation. Still, many HCV-positive organs otherwise do meet the donation criteria, and the use of these organs could potentially increase the amount of available donations and help save patient lives.4
There are many reasons why experts are beginning to allow the transplant of HCV-positive organs. Most HCV-positive patients are younger than the average organ donor, and they are less likely to have other conditions that could prevent a healthy organ transplant.1 In addition, there are better, more improved criteria established to prevent the accidental transmission of infectious disease like HCV through organ transplant.1 But most recently, the development of successful treatment for HCV have improved the health of HCV-positive patients, leading to a cure in disease and preventing organ damage.1
Direct-acting antivirals, or DAAs, are short-course treatments available to HCV-positive patients that offer a cure for disease. The continued research and development of DAAs have lead to more effective, safer treatment options without side effects or potential damage to organs or the renal system.1 So patients who were HCV-positive are often able to offer healthy organs for donation post-cure. In addition, DAAs have been able to successfully treat donor recipients after transplant of HCV-positive organs.1
Studies have proven successful outcomes for patients receiving HCV-positive donor organs. A recent article in the New England Journal of Medicine found that patients receiving heart and lung transplants from previously infected donors had positive outcomes.1 Similarly, another study following the HCV-positive kidney transplants of patients with kidney failure found that transplant was successful, and HCV was cured when DAAs were given to the patients after the transplant.4
Hope for the future
Last year, nearly 2,000 HCV-positive organs were transplanted, the majority of which went to patients without HCV. The ability to use these organs for patients needing transplants not only shortens the transplant waiting lists, but also potentially saves lives that would have otherwise been lost without transplant.2
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