Extending the criteria for acceptable organ donors: balancing the risks

Kotecha, Sakhee; Williams, Trevor J

doi:10.5694/mja2.50370

Topics

Surgical procedures, operative

Infectious diseases

Environment and public health

Understanding the low risk of blood‐borne virus infections in donors could help expand the pool of available organs

Solid organ donation and transplantation rates in Australia have increased in recent years, but demand continues to exceed supply.1 Morbidity and mortality for people on the waiting list remain problems, and strategies to expand the donor pool include accepting donations after circulatory death and adopting extended criteria for acceptable donors.2

1 Alfred Hospital, Melbourne, VIC
2 Monash University, Melbourne, VIC

Correspondence: t.williams@alfred.org.au

Competing interests:

No relevant disclosures.

1. Australia and New Zealand Organ Donation Registry. Organ waiting list. https://www.anzdata.org.au/anzod/reports/organ-waiting-list (viewed June 2019).
2. Rakhra SS, Opdam HI, Gladkis L, et al. Untapped potential in Australian hospitals for organ donation after circulatory death. Med J Aust 2017; 207: 294–301. https://www.mja.com.au/journal/2017/207/7/untapped-potential-australian-hospitals-organ-donation-after-circulatory-death
3. Kucirka LM, Sarathy H, Govindan P, et al. Risk of window period HIV infection in high infectious risk donors: systematic review and meta‐analysis. Am J Transplant 2011; 11: 1176–1187.
4. Kucirka LM, Sarathy H, Govindan P, et al. Risk of window period hepatitis‐C infection in high infectious risk donors: systematic review and meta‐analysis. Am J Transplant 2011; 11: 1188–1200.
5. Waller KMJ, De La Mata NL, Kelly PJ, et al. Residual risk of infection with blood‐borne viruses in potential organ donors at increased risk of infection: systematic review and meta‐analysis. Med J Aust 2019; 211: 414–420.
6. Australia and New Zealand Dialysis and Transplant Registry. Mortality in end stage kidney disease. In: ANZDATA 41st annual report (2018). Adelaide: ANZDATA, 2018. https://www.anzdata.org.au/wp-content/uploads/2018/11/c03_mortality_2017v1.0_20181122.pdf (viewed June 2019).
7. Australia and New Zealand Liver Transplant Registry. 29th registry report 2017. Brisbane: ANZLTR, 2017. https://www3.anzltr.org/wp-content/uploads/Reports/29thReport.pdf (viewed June 2019).
8. Australia and New Zealand Cardiothoracic Organ Transplant Registry. 2018 report. http://www.anzcotr.org.au/pub/e0cc941a/PDFS/ANZCOTR2018_text.pdf (viewed 24 June 2019).
9. Günthard HF, Saag MS, Benson CA, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults. JAMA 2016; 316: 191–210.
10. Defresne F, Sokal E. Chronic hepatitis B in children: therapeutic challenges and perspectives. J Gastroenterol Hepatol 2017; 32: 368–371.
11. Liu SK, Seto WK, Lai CL, Yuen MF. Hepatitis B: treatment choice and monitoring for response and resistance. Expert Rev Gastroenterol Hepatol 2016; 10: 697–707.
12. Vallet‐Pichard A, Fontaine H, Mallet V, Pol S. Viral hepatitis in solid organ transplantation other than liver. J Hepatol 2011; 55: 474–482.
13. Mohanty SR, Cotler SJ. Management of hepatitis B in liver transplant patients. J Clin Gastroenterol 2005; 39: 58–63.
14. D'Ambrosio R, Degasperi E, Colombo M, Aghemo A. Direct‐acting antivirals: the endgame for hepatitis C? Curr Opin Virol 2017; 24: 31–37.
15. Goldberg DS, Abt PL, Reese PP; THINKER Trial Investigators. Transplanting HCV‐infected kidneys into uninfected recipients. N Engl J Med 2017; 377: 1105.
16. Schlendorf KH, Zalawadiya S, Shah AS, et al. Early outcomes using hepatitis C‐positive donors for cardiac transplantation in the era of effective direct‐acting anti‐viral therapies. J Heart Lung Transplant 2018; 37: 763–769.
17. Woolley AE, Singh SK, Goldberg HJ, et al; DONATE HCV Trial Team. Heart and lung transplants from HCV‐infected donors to uninfected recipients. N Engl J Med 2019; 380: 1606–1617.
18. Snell GI, Westall GP, Oto T. Donor risk prediction: how “extended” is safe? Curr Opin Organ Transplant 2013; 18: 507–512.
19. Eberlein M, Reed RM. Donor to recipient sizing in thoracic organ transplantation. World J Transplant 2016; 6: 155–164.

Online responses are no longer available. Please refer to our instructions for authors page for more information.