Introduction

Donors with an increased risk of transmitting HIV, HBV or HCV (IRDs) are a potential source of organs. There is a lack of data on IRD utilization in jurisdictions outside the U.S., especially in countries where nucleic acid testing (NAT) may not be universally available. We reviewed the characteristics and utilization of IRDs in a Canadian OPO over a two-year period.

Methods

Donor information from April 1, 2013 to March 31, 2015 was obtained through the OPO database. Only consented donors were included. Donors were categorized as IRD according to criteria defined by Health Canada.

Results

494 potential donors were identified, of which 92 (18.6%) were considered as IRD. Of these, at least one organ was transplanted from 76 (82.6%) patients. Risk factors for IRDs included previous injection drug use (13%), men who have sex with men (MSM, 8%), commercial sex worker (CSW, 4%), incarceration (24%) and nonsterile piercings/tattoos (57%). Fourty-eight percent (253/524) of potential IRD organs were transplanted. The most frequently used organ was kidney, followed by liver. Median number of organs transplanted per IRD was 3 (range 1-7).

NAT testing was done in 7.5% (37/494) total donors and 18% (17/92) of IRDs; NAT was positive only in 1 patient (HCV) who was also HCVAb+. In IRDs, reasons for NAT testing were injection drug use (n=2), MSM (n=2), CSW (n=2) and previous incarceration (n=7). In the total cohort, the majority of patients who had NAT testing had a history of non-injection drug use (32/37 NAT tested total donors or 13/17 NAT tested IRDs). Organs from donors that had NAT testing were somewhat more likely to be used than donors who were not NAT tested (94% vs 80%, p=0.29).

In recipients, no clinical cases of transmission were reported but followup testing was variable (eg, in a subset of 21 recipients of IRD organs, only 3 had post-transplant NAT testing and 3 serological testing).

Conclusion

Utilization of IRD organs occurs at a significant rate in our OPO. NAT testing is recommended only for donors that meet the IRD criteria but is inconsistently performed and many IRDs are used without NAT testing which is not optimal. Since this review, a NAT testing algorithm has been implemented. Our study highlights important areas for quality improvement for use of IRDs.

CITATION INFORMATION: L'Huillier A, Humar A, Payne C, Kumar D. Review of Organ Utilization from Increased Infectious Risk Donors. Am J Transplant. 2016;16 (suppl 3).

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