A pharmaceutical cure for hepatitis C and the availability of otherwise healthy donors have expanded opportunities for lifesaving organ transplants for persons who could spend years waiting or even die while on a transplant list.
Henry Randall, M.D., executive director of Abdominal Transplant Center at Saint Louis University Hospital, said the hospital has been using hepatitis C-positive donations for about 18 months.
“We embarked on this journey to meet the needs of the local and regional community,” he said. “To date, we’ve performed roughly 20 such transplants, both liver and kidney, using hep-C positive donors and have successfully treated a group of patients.”
Randall said the other reason these organs are more readily available is a result of the opioid crisis – they are overdose death donors.
“A lot of these donors we are using are young, healthy people who have been entangled in the opioid crisis and drug use from opioids or from heroin,” Randall said. “They are young, healthy people otherwise. They’ve shared needles, they’ve contracted hep C; so from an organ utilization standpoint, these are essentially really perfect donors other than having overdosed on some opioid.”
Hepatitis C is a viral infection of the liver, contracted and spread by contact with contaminated blood or other bodily fluids. Sharing of needles in drug use is one of the most common ways to get hep C. Sharing straws to snort cocaine, improperly sterilized medical equipment and items shared that pierce the skin can also transmit the virus.
Just last week, the American Heart Association (AHA) announced that heart transplants from donors who had hepatitis C may be safe for transplanting.
"The dramatic increase in the rate of [overdose death donor] utilization was striking, and it has increased concordantly with the rate of overdose deaths," Nader Moazami M.D., a heart transplant surgeon at NYU Langone Medical Center in New York said last year in a publication of the American Association for the Advancement of Science. "The significant impact of the opioid epidemic on transplantation is one of the major reasons that organ transplant numbers have increased over the last several years."
Research published in the AHA Journal found the one year-survival rates for adults with severe heart failure who received heart transplants from donors with hepatitis C and those without hepatitis C had similar survival rates.
Their study included more than 7,800 adult heart transplant patients at 128 medical centers from January 2016 through December 2018. Four percent of those recipients received hearts from donors who were infected with hepatitis C. The research revealed that 90 percent of patients whose donors had hepatitis C survived, compared to a 91 percent survival rate for the patients whose donors did not have the infection. The rates of drug-treated organ rejection, kidney dialysis to remove toxins from the blood and stroke were also similar between the two groups of patients.
“We are encouraged by these results and believe this is a landmark change in our ability to better meet the demand for heart transplantation by increasing the donor supply,” said Arman Kilic, M.D., lead study author, assistant professor of cardiothoracic surgery, director of surgery quality and analytics, and co-director of the Center for Cardiovascular Outcomes and Innovation at the University of Pittsburgh Medical Center in Pennsylvania. “It is our hope that more centers will use hepatitis C-positive donors for heart transplantation.”
Randall said about six weeks after an organ transplant from a donor who had hepatitis C, patients undergo an eight-week treatment for hepatitis C.
“We’ve done kidneys, we’ve done livers. We’ve not done any pancreases – we don’t do hearts here, or lungs, but several places around the country have started doing heart and lung transplants using these hep C-positive organs,” Randall said. “It’s already expanded over to thoracic, to heart and lungs; we use it in livers and kidneys; we may eventually start to consider kidneys and pancreases or pancreas as a transplant .”
The Organ Procurement and Transplantation Network reports overall organ donations again hit a record high in 2019.
“Deceased donation has increased by 38 percent since 2014,” said Maryl Johnson, M.D., board president for the Organ Procurement and Transplantation Network. “This staggering increase is a tribute to the dedication of donors and their families nationwide who make the courageous decision at a time of great personal loss to give the gift of life to people who are awaiting organ transplantation. While we recognize the sacrifices that have been made to make the increase possible, we are steadfast in continuing to serve the needs of nearly 113,000 people who are still awaiting a transplant.”
“If you need an organ transplant that, because of the research that has been done and the addition of these new antivirals, we always talk to patients about whether or not they will accept the hep C organ,” Randall said. “Be open to accepting a hep C organ because the antiviral treatment is so good. It shortens the amount of time sometimes people have to wait for an organ. In this area, let’s say for a kidney or liver, it’s about three years, and if these organs become available, you might get transplanted in weeks or months instead of waiting for years.”