Increased risk donors may be significantly more likely to be hepatitis C virus (HCV)- and hepatitis B virus (HBV)-positive compared with standard risk donors, according to a Morbidity and Mortality Weekly Report.
In the United States, the ongoing opioid crisis, which has affected younger people the most, has resulted in an increase in drug overdose deaths and acute HCV infections in young people who might be eligible organ donors. To reduce the risk for unintended organ transplantation-associated HBV, HCV, and HIV transmission, the Public Health Service released a revised guideline in 2013 that described criteria to categorize donors at increased risk for transmitting these viruses to recipients and recommends universal donor testing for HBV, HCV, and HIV. Therefore, this report analyzed data for all deceased solid organ donors with 1 or more organs recovered for transplantation from 2010 to 2017.
Data was collected from the United Network for Organ Sharing, where organ procurement organizations and transplant centers report organ data. Trends in demographic characteristics and HBV, HCV, and HIV screening results from all donors and by donor risk type were assessed along with the change in the percentage of increased risk donors, standard risk donors, drug intoxication reported as the mechanism of death, and injection drug use history, along with comparisons of HBV and HCV screening results between increased risk donors and standard risk donors. From 2010 to 2017, anti-HCV and anti-HIV screening results were used, but with the implementation of the guideline recommendation for HCV and HIV testing by nucleic acid test in 2014, screening was adjusted accordingly from 2014 to 2017.
From 2010 to 2017, the annual number of deceased donors increased by 29.5%. The number of deceased donors with drug intoxication reported as the mechanism of death increased from 4.3% in 2010 to 13.4% in 2017 (P <.001). In donors with drug intoxication as the cause of death, the number with injectable drug use history increased from 1.3% to 8.0% from 2010 to 2017, respectively (P<.001). Over the same time period standard risk donors decreased from 91.0% to 73.7%, whereas, increased risk donors increased from 8.9% to 26.3%. In standard risk donors, mean age was 41.0 years, 58.2% were men, and 65.4% were white. In increased risk donors, mean age was 35.2 years, 66.3% were men, and 70.0% were white.
In the group of increased risk donors there were no substantial changes in HBV surface antigen or antibodies to HBV core antigen positivity. However, anti-HCV positivity increased from 15.9% to 21.6% and HCV RNA positivity increased from 8.6% to 15.7%. During this time period, the percentage of increased risk donors tested by HCV increased from 4.6% to >99.9% and the percentage of increased risk donors tested by HIV nucleic acid test increased from 4.5% to 99.9%. Compared with standard risk donors, increased risk donors were significantly more likely to be positive for antibodies to HBV core antigen, HBV DNA-positive, anti‑HCV-positive, and HCV RNA-positive (all P <.001). Of note, there were no significant differences in HIV serostatus of organ donors in either standard risk donors or increased risk donors.
Overall, the study authors concluded that, “Identification of HBV, HCV, and HIV risk factors among organ donors is critical to mitigate transmission risk and ensure monitoring and appropriate treatment of recipients for posttransplant infection.”
By Zahra Masoud
Abara WE, Collier MG, Moorman A, et al. Characteristics of deceased solid organ donors and screening results for Hepatitis B, C, and human immunodeficiency viruses- United States, 2010-2017. MMWR. 2019;68(3):61-66.