One potential approach to overcome the significant shortage of organs available for transplantation is the use of donors with risk factors that are associated with increased risk of transmitting HIV, HBV, and HCV despite current screening practices. This risk of transmission posed by such donors is exceptionally low (ranging from 0.035 to 300.6 undetected infections per 10,000 donors) and dependent upon the donor risk factor, virus of interest, and screening tests utilized. Despite this low risk, there is significant variability in the use of such organs by organ type and across regions of the United States. Some of this variability may be the result of variations in what represents an unacceptable level of risk, variations in classification of donors as increased risk, and variations of knowledge about the extent of risk posed by organs from increased risk donors by the providers and candidates. Optimal screening to mitigate risk among living donors has not been formally established and post-transplant follow-up from recipients of living or deceased donors with factors associated with increased risk of HIV, HBV, and HCV transmission has not been examined in standardized way. As a result, there are challenges to optimal use of organs from donors with risk factors and limited data to guide future policy decisions. We therefore proposed a conference to bring together leaders in the field of solid organ transplantation to review research findings and evidence-based information. The conference will develop a consensus about the optimal evaluation and classification of living and deceased donors at increased risk of disease transmission in addition to optimal informed consent and post-transplant evaluation of recipients of organs from such donors with the goal of improving the outcomes, quality, access to, and utilization of such organs. The reviewed findings and consensus opinions will be published to disseminate this information to members of the wider transplant community. Further, the group will also develop a rational research agenda or strategy for studying: the optimal definition of donors at increased risk of transmission of HIV, HBV, and HCV, the optimal evaluation of living donors to mitigate against infectious disease transmission, the optimal timing, content, and method of informed consent of candidates considering accepting an organ from a donor at increased risk of infection and the optimal evaluation of recipients of organs from donors at increased risk of infection transmission.
This project will fund a conference to bring together leaders in the field of solid organ transplantation to review research findings and evidence-based information about optimal evaluation and classification of donors at increased risk of disease transmission in addition to optimal informed consent and post-transplant evaluation of recipients of organs from such donors. The goal of this effort is to improve the outcomes, quality, access to, and utilization of such organs and produce a consensus document to disseminate this information to members of the wider transplant community. Further, the group will define issues and problems in the practice and delivery of solid organ transplant related to donors at increased risk of disease transmission and will develop a rational research agenda or strategy for studying these problems.
| Echenique, I A; Cohen, D; Rudow, D L et al. (2014) Impact of repeat testing of living kidney donors within 14 days of the transplant procedure: a multicenter retrospective survey. Transpl Infect Dis 16:403-11 |
