As the Trump administration eyes easing organ transplant restrictions, new research shows advances in hepatitis C treatments could create a whole new group of donors.
When comparing heart transplant patients' survival rates, researchers found no significant differences between patients who received organs from hepatitis C-positive donors and uninfected donors. The study published Wednesday in JAMA Cardiology reviewed 80 heart transplant patients' results.
Using hepatitis C-infected hearts in uninfected recipients could expand the donor pool, particularly for rural areas where available donors are limited and hepatitis C rates have risen due to the opioid epidemic, according to lead study author Dr. Kelly Schlendorf, medical director of the adult heart transplant program at Vanderbilt University Medical Center in Nashville.
Tennessee had the 15th-highest rate of drug overdose deaths among states in 2017 at 26.6 for every 100,000 individuals, according to the most recent figures from the Centers for Disease Control and Prevention.
"These donors offer a very viable means of expanding the donor pool that seems to be safe," Schlendorf said. "Based on where (transplant) centers are located throughout the country, some centers may benefit more from this strategy than others."
Vanderbilt's donor pool has increased significantly since it started accepting hepatitis C-positive donors in September 2016, she said. They now account for 37% of all adult heart transplants at the health system. Vanderbilt performs twice as many heart transplants since the change, jumping from 130 between 2013 and 2015 to 260 between 2016 and 2018.
Using hepatitis C-infected hearts significantly reduced wait times for recipients, according to the study. Median wait times range from 70 to 535 days depending on a patient's blood type, the most recent data from HHS' Organ Procurement and Transplantation Network shows. VUMC patients who consented to receiving a heart from hepatitis C-positive donors had a median wait time of four days.
In 2018, more than 950 patients died while waiting for a transplant or were removed from the wait list because they became too ill.
In the past, clinicians opposed using hepatitis C-infected organs for transplant because the disease's treatment regimen had harsh side effects and a cure rate of about 50%. Those transplant recipients often had poorer outcomes, including higher rates of organ rejection.
But that mindset started to change in 2011 when direct-acting antiviral medications came on the market, which increased the cure rate to over 95% and included fewer and milder side effects, according to Dr. Maria Rosa Costanzo, a volunteer expert for the American Heart Association and medical director of heart failure research Advocate Aurora Health's Heart Institute.
Only one heart transplant in 2015 involved a hepatitis C-positive donor, compared with 154 as of September 2019, according to the most recent OPTN figures.
"There were a lot of beliefs about acceptable versus unacceptable donors," Costanzo said. "I think we are in an era where a lot of the former beliefs are turning out not to cause a worse outcome in recipients."
The study was published a day after the Trump administration proposed changes to the organ transplantation procurement process. The changes include allowing living donors to be reimbursed for lost wages and hospitalization expenses and creating tougher reporting standards for procurement organizations. The administration hopes the changes will lead to more available donors.