Australian research suggests organs once deemed too risky for transplant may actually be safe.
The study, published in the Medical Journal of Australia, says it may be safe to transplant organs from donors with high-risk behaviors, as long as the donor tests negative for blood-borne viruses like HIV and any type of hepatitis.
The study team says many donors are rejected due to the perceived risk of infection to the recipient. International guidelines frequently reject donors who:
- inject drugs intravenously;
- work as sex workers;
- are homosexual;
- spent time in jail;
- or had sex with a person with a high-risk lifestyle.
"People from these groups are often declined as organ donors, even when tests for blood-borne viruses are negative, and sometimes without even being tested," write Karen Waller and Angela Webster, two of the study's authors.
The authors say some organs that test negative for blood-borne viruses aren't used because it's assume the virus isn't showing up on lab panels. Doctors assume the donor is in the "risk period" and a virus could unknowingly be transferred to a recipient.
"We believed the risk of window-period infection in Australia was likely to be lower, possibly much lower, than was appreciated. So, we were concerned some potential donors might be turned away who could actually have donated safely," the authors write.
To determine if these organs were actually safe, researchers looked 19 years’ worth of journal articles, governmental studies and conference abstracts to discover how common blood-borne viruses are among people with high-risk behaviors in Australia.
"We found, as expected, men who have sex with men have the highest risk of HIV in Australia. But for each person who tests negative for HIV, the risk of transmitting the virus was around one in 6,500. This is lower than the U.S. estimate, which sits at one in 2,500," the authors say.
Australian IV drug users were deemed even less risky. One in 50,000 were found to have window-period infection, compared to one in 2,000 in the U.S. The risk of hepatitis C was more in line with international estimates. In Australian the risk of a window-period infection of hepatitis C is one in 500.
The research team says instead of looking for markers of infections in serological testing, organ centers should test for the presence of the virus itself using DNA or RNA testing. This will minimize the risk of missing a recent infection.
"For potential donors who test negative, our data can be used to help clinicians put the small risks of infection transmission in context for organ recipients," the authors write.
There's been much discussion in the U.S. regarding organ donations from people who die as a result of a drug overdose. Even so, the number of organs that come from donors with high-risk behaviors has increased. Between 2010 and 2017, 25% of solid organ donations came from people who exhibited high-risk behaviors.
While there hasn't been an increase in the number of recipients who acquire HIV or hepatitis B, cases of hepatitis C have been increasing. Fortunately, hepatitis C can be effectively treated, even among transplant patients.
